Lisa Bergquist, GPJ
KATHMANDU, NEPAL – More than 13,000 people died in the decade-long civil war in Nepal, when Maoist rebels fought to depose the government and establish a “People’s Republic.”
The 10-year conflict, which ended in 2006 with a peace accord, was bloody and brutal, and spread to 73 of Nepal’s 75 districts; only the rural, isolated districts of Manang and Mustang were spared.
“The economy was disturbed, development obstructed and the environment degraded,” says Bishnu Raj Upreti, executive director of the non-profit Nepal Center for Contemporary Research. “There was erosion of trust, and tension between communities.”
An estimated 1,300 people went missing, and more than 8,000 people are disabled as a result of the conflict.
In addition to the serious violations and abuses of international human-rights and humanitarian law – including unlawful killing, torture, enforced disappearance, sexual violence and long-term arbitrary arrest – thousands of people were directly or indirectly affected by the conflict in other ways. Many individuals and families were displaced from their homes. There were large-scale disruptions to education, health and basic government services across the country.
Economic hardships were exacerbated by the conflict, and instability and a climate of fear were widespread, according to a report on the Nepal conflict by the United Nations Office of the High Commissioner for Human Rights published in October 2012.
The impact of the conflict on the mental health of Nepalese people is undeniable, according to a study published in 2012 in the British Journal of Psychiatry. The study, “Political Violence and Mental Health in Nepal,” examined the same group of people in the early years of the Maoist insurgency and after the conflict ended. It noted a 21.5 percent increase in anxiety over that time.
The study, authored by medical anthropologist and psychiatrist Brandon Kohrt and others, also found that pre- and post-conflict conditions, especially social injustices among marginalized groups, factor heavily into how well people handle the trauma of conflict.
When a 7.8-magnitude earthquake hit Nepal in April, mental-health needs there increased again. (See our Earthquake in Nepal: Continuing Coverage.) Hundreds of aftershocks, some severe, forced people out of their homes and into tents for months. Some Nepalese families have yet to move back indoors for fear that their homes will collapse on them.
The Maoist insurgency and the earthquake occurred in a country with little capacity for dealing with mental-health issues. There are an estimated 0.2 psychiatrists per 100,000 people in Nepal, according to the World Health Organization’s 2014 Mental Health Atlas.
In contrast, there are about 14.63 psychiatrists per 100,000 people in the United Kingdom, according to the atlas.
There is some evidence, however, that the earthquake focused global attention on the need for mental-health care in Nepal. Mental-health specialists traveled there, alongside physicians and other medical staff, to provide care and training in the days and weeks after the earthquake. Organizations including International Medical Corps and Kohrt’s organization, HeartMind International, are addressing mental-health issues related to the earthquake as well as pre-existing conditions.
