The mental agony of pellet-gun victims in Kashmir

The two-year-old Hiba has seen a lot for her age: she knows how an operation theater looks like; the frightening clattering of surgical instruments; the piercing pain of a syringe; the sharpness of a surgeon’s knife sliding into her eyeball. The second word she learnt after mother was eye and probably the next one will be pain. The two-year-old Hiba has seen a lot for her age: she knows how an operation theater looks like; the frightening clattering of surgical instruments; the piercing pain of a syringe; the sharpness of a surgeon’s knife sliding into her eyeball. She can’t express the unexplainable pain she is going through; she doesn’t have the words for it, and so she cries. Sometimes she points her tiny fingers towards her operated eye and sometimes, when the bandage on eye suffocates or irritates her, she tries to get rid of it.

On the morning of 25 November 2018, the then 18-month-old Hiba was playing with her brother Shahadat in their home in Kapran, a village in the militancy-affected Shopian district of Indian-occupied Kashmir. In the early morning, there had been a clash between Indian soldiers and militants in Batgund, a neighboring village, and a group of people congregated in Kapran to protest in order to break the cordon-and-search operation of the Army and to help the holed-up militants to escape. Not aware of what was happening a few hundred meters away from her home, Marsala Jan, Hiba’s mother, was busy making breakfast.

“Had I known anything would happen here, I would have taken the children to a safe place,” Marsala said.

As the anti-India slogans filled the air, the Army fired teargas shells to disperse the youth who were disrupting the operation. The teargas canisters were fired very close to Hiba’s home and the air inside the house was getting dense with smoke.

“I felt choked, my son struggled breathing and Hiba started vomiting. Their eyes turned red, I thought we might die,” Marsala said remembering that fateful morning.

As the situation worsened, seeing no other options, she opened the door of the house to get some air and pushed the children towards the internal corridor. Suddenly she found herself surrounded and the next moment a security personnel aimed a pellet gun at her and fired. Hiba was in her arms. “I pushed my son aside and covered Hiba’s face with my hand,” Marsala recalled. But there was no escape. Hiba trembled in pain and blood oozed out of her eye turning her face red.

One cartridge of a pellet gun contains a few hundred lead pellets, which come in different shapes. When fired from pump-action shotguns, they don’t follow a definite path. One of those hot pellets made a hole in Hiba’s right eye and ruptured parts critical for vision. Since then she has gone through multiple surgeries.

Two wars, separatist movements, non-violent struggles, rapes, enforced disappearances, torture, unmarked mass graves and other human rights violations have been part of the daily life of Kashmiris for the past decades. When pictures of Hiba, one of the youngest pellet victims in Kashmir, with a bandage on her eye emerged in the media, it brought public anger back on the streets of the Himalayan region. Two wars, separatist movements, non-violent struggles, rapes, enforced disappearances, torture, unmarked mass graves and other human rights violations have been part of the daily life of Kashmiris for the past decades.

In Kashmir, some carry the scars of the conflict on their soul; Hiba carries it on her face.

“Why did they fire at her? She has not picked up any stone. She was not protesting. What was her fault?” asked Marsala. “It’s only us, who understands her pain. As she grows older, she will ask us: what happened to me? Why has this happened to me?”

Used in Kashmir since 2010, even though it is officially identified as a “non-lethal” weapon, the pump-action pellet gun could lead to severe organ damage, disfigurement or even death. According to a recent report, between July 2016 and February 2019, 2,942 Kashmiris were injured, and eighteen people killed by pellets. According to an India Spend report in August 2019, out of the total injuries caused by pellets, 1,459 people got eye injuries and 139 lost their vision. In January 2018, the Jammu & Kashmir State Government told the State Legislative Assembly that between July 2016 and February 2017 more than 6,000 people received pellet gun injuries, including 782 eye injuries. Many of the victims don’t go to hospitals for fear of being targeted and imprisoned by the police later.

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The level of violence that Kashmir is experiencing daily is impacting the mental health of its citizens and children are the most affected by the conflict.

Marsala Jan has perceived that Hiba’s behavior has changed since that horrible incident. “Prior to the injury she was a very soft girl. Now she doesn’t eat properly and gets easily irritated. The injections, surgeries, and medicines have made her a rough child.”

A study conducted by Srinagar’s Institute of Mental Health and Neuroscience (IMHANS) reports that the number of children treated in the psychiatric ward of the hospital has almost doubled between 2016 and 2019, i.e. 30,000 from around 17,000. A renowned psychiatrist at the Government Medical College in Srinagar, Dr. Arshad Hussain has been treating patients affected by the psychological impact of conflict for a long time. According to him, traumas act very differently in kids and adults: “The trauma [kids] undergo actually affects their development and some of them might have personality changes, which are very pervasive.” A study conducted by Srinagar’s Institute of Mental Health and Neuroscience (IMHANS) reports that the number of children treated in the psychiatric ward of the hospital has almost doubled between 2016 and 2019, i.e. 30,000 from around 17,000.

As a result of the conflict, there is an alarming level of mental health disorders in the population of Kashmir. A 2015report by Médecins Sans Frontières (MSF) observed that 1.8 million (45%) adults in the Kashmir Valley are suffering from symptoms of mental distress, 41% display probable depression, 26% have anxiety, and 19% are ailing from Post-Traumatic Stress Disorder (PTSD).

“Hiba is restless since the incident. She wakes up five/ten times a night, gets up and walks around. She was not like that before.” Tears rolled from Marsala’s eyes.

Childhood trauma can have enduring effects and can lead to the development of PTSD as well as to a variety of other psychiatric disorders, including depression, panic attacks, and borderline personality disorders.

“They live with fear throughout their life. They approach life through those fears. They are not able to live a normal and enjoyable life,” Dr. Arshad added. Children often can’t express the distress they are feeling in a way that is easily recognizable. Hiba doesn’t speak much. She tries to reveal her pain in her toddler’s language by just pointing towards her eye. She has not recovered her eyesight yet, and doctors are not sure whether she ever will. It’s up to God now, they say.

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In another corner of Kashmir, 32-year-old Zohaib is frustrated and disappointed with such consoling expressions. “Khuda Kari Sahal (God will take care of it) – I am fed up with this shit! God is not taking care of me. It’s you and yourself. It’s you that has to deal with it. No one else.”

Like any other routine day, on 4 September 2016, Zohaib, a freelance photojournalist, was covering a protest in Srinagar’s Rainawari area, just half a kilometer away from his home. It was the 58^th day after the killing of young militant leader Burhan Muzaffar Wani. Around sixty people were offering prayers on the roadside as a sign of protest, but the gathering enlarged, and anti-India slogans turned into stone pelting towards the police that had already arrived with bulletproof vehicles. Zohaib was clicking pictures from the protestors’ side with two other photojournalists. Soon the event turned chaotic and the protestors start running while the police were chasing them.

“I told the other guys to leave the spot where the stone pelting was happening, and we ran some 100 feet away from the protest.”

They took shelter in an alley close to Zohaib’s home and relaxed thinking they were now far from the trouble. One of the photojournalists was speaking on the phone, another was clicking pictures with his telephoto-lens while Zohaib lit a cigarette. Suddenly a cop in a cargo T-shirt appeared with a rifle twenty just meters away on Zohaib’s left. Six feet tall with a couple of DSLRs around his neck, Zohaib raised his camera to indicate the policeman that he was a journalist, but within the fraction of a second the man in uniform pulled the trigger. Zohaib heard a big bang.

“For the first 15 seconds I cried like a dog in pain. I was hell confused about what had happened because my mind and body were not able to understand or judge clearly.”

The other two kneeled down and were only marginally injured by the volley of pellets. For Zohaib, the contact was so close that two metal pellets pierced his fiberglass goggles, one tore the eyelid, the second went through the cornea and damaged the corner of the retina in his left eye. “I was in pain but conscious. I somehow calmed myself and ran towards my locality covering my bleeding eye with a handkerchief.” From there, a neighbor arranged a motorcycle to rush him to a nearby hospital. Since then, Zohaib has undergone more than six surgeries hoping to recover some light in his eyes, but all proved futile. He is planning on further surgeries, but there is no guarantee that he will ever get his vision back. The upper part of his body also still carries more than 300 metal pellets: “I have six pellets in my face, on the chin, one on the cheek, one in the nose. If you touch, you can feel it. The metal rolls everywhere in my body.”

After surgeries he was kept in a dark room for seven months and for three months he had to sleep in a prone position keeping his face to the ground. After the surgeries, Zohaib can now see only shadows from his damaged eye, which he says is a scary experience. When he returned home after hospital, he was surrounded by a lot of people, but he now only keeps to himself. If he is not working as freelance anchor for the government radio station, he prefers to stay in his room — alone. Noise and gatherings irritate him. If he leaves his house, he always keeps his shades on: a mask so that others don’t feel pity on his condition. And when he is alone, he cries on what has happened to him. “Deep inside, you know, you are handicapped. You can’t do this. You can’t do that, it’s not like it used to be before, it is as if you have suddenly become dependent on others,” said Zohaib caressing the metal in his face.

Once, as a photographer, he played with colors and lights; now colors and lights play with him.

What started as a physical injury turned into psychological and mental distress. The memory of the incident still haunts him. What started as a physical injury turned into psychological and mental distress. The memory of the incident still haunts him. Sometimes he can’t sleep for a week and when he sleeps, he doesn’t have dreams: “I have nightmares,” he said. His family and friends believe that Zohaib is numb to emotions because he doesn’t want to be participate in anyone’s joy or sorrow. And the psychiatrist who is counseling him thinks that he is ‘vulnerable’ to suicide.

Instead of the DSLRs, painkillers are now part of Zohaib’s life: “Now I have to plan a date with my girlfriend in advance because I have to take fucking painkillers for two hours before visiting her. That’s my life now.”

After many decades of conflict, Kashmiris and trauma have become synonyms. After many decades of conflict, Kashmiris and trauma have become synonyms. According to a Médecins Sans Frontières 2016 report, 93% Kashmiris have experienced conflict-related trauma and an average adult has witnessed around eight traumatic events during his/her lifetime. According to Dr. Hussain, depression in Kashmir touches 7.3% of the population as compared with 4% in India, which is already higher than global standards. People who are affected by PTSD are stuck in their trauma as something that did not end in the past but keeps happening now, every day, every minute. They slowly fall into what Dr. Arshad called “the black hole of trauma where they are continuously re-experiencing it.” That becomes the reality of their life; in their thoughts, in their actions, in their dreams, in their nightmares, it’s all about the trauma that they witnessed and are still witnessing. A never-ending cycle of restlessness, pain and misery.

A new research titled ‘Psychiatric Morbidity in Pellet Injury Victims of Kashmir Valley’ conducted by the Government Medical College in Srinagar draws a grim picture of the mental health situation in the Valley. The report was prepared over a period of two years from August 2016 to August 2018 and showed that in Kashmir 25.79% people are suffering from depressive disorders; 15.79% from adjustment disorder; 9.21% have Post Traumatic Stress Disorder; 7.89% suffer from generalized anxiety disorders. According to the study, at least 85% of pellet victims have also developed psychiatric disorders. The doctors from Orthopedics and Ophthalmology departments of Government Medical College examined 380 pellet- and pellet-plus-firearm-injury victims since the 2016 civil unrest for the study. The report indicates that psychological disorders in pellets victims are directly associated with the severity of the injuries. Of all the pellets victims’ psychiatric morbidity, those with eye injuries are 91.92% as compared with 70% of victims hit by pellets in other parts of the body.

“I have never told this to anyone but once I was doing my radio show, and while playing a song I thought about committing suicide,” Zohaib told me.

Data show that depression is one of the most common causes of suicides all over the world. In Kashmir, where in the local language there isn’t even a word to mean suicide, there is a sharp rise in actual suicide cases. In Kashmir, where in the local language there isn’t even a word to mean suicide, there is a sharp rise in actual suicide cases. “Currently if you go to any hospital, in any emergency ward, you will see that the patients who attempted suicide are increasing. And most of it is because of mental health issues – and of course this is partly caused by the conflict as well,” said Dr. Arshad.

According to different media reports, it has been difficult for people in the Valley to access health facilities. Hospitals have reported a drop in the number of patients since 5 August, when the Indian Government unilaterally repealed Article 370 of the Constitution resulting in a long communications blockade that has prevented millions from talking to their families or stepping out of their home for fear of harassment by the armed forces.

On 17 August, an editorial in the British medical journal The Lancet noted that “the prolonged exposure to violence” has led to a “formidable mental health crisis” with increased levels of “anxiety, depression and post-traumatic stress disorder” in the Valley. A Kashmiri doctor, Dr. Umar Salim, from the Government Medical College, was arrested by the police last month after he spoke to an international media outlet, warning of the critical shortage of lifesaving medicines and the increase in deaths because of prolonged restrictions on public movement and the communication blackout in the State.

With the present humanitarian crisis in the Valley, people’s emotional and mental health is expected to worsen. The communication blackout and the restriction of movements has crippled daily life and has left the people of Kashmir in a state of increased panic, humiliation and constant mental agony.