It was expected that the 21st century would be a century of peace along with technological advancement and globalization. But unfortunately,this century witnessed huge destruction to humanity caused by violence such as warfare, ethnic and racial violence, massacres, prejudice and discrimination. As a result, uncontrolled anger causes the disintegration of intimate relationships and prevalence of sexual, emotional and physical abuses. In deed anger is prevailed worldwide. In this review we focused on the current wave of terrorism in swat valley in Northwest Frontier Province (NWFP) of Pakistan. Hence the damage caused by suicides, attacks, explosions, and curfews has no match. And on-going insurgency among the security forces and insurgents led the local population into constant threat. This causes the psychological impairments in the people of the valley. So, the psychological trauma is prevailing all over the area which impacts the psycho social functioning as the individuals are manifesting symptoms of psychological trauma.
Terrorism in Swat Valley and Psychological Emergency
This article aims to explore the consequences of persistent terrorism in swat valley contributed by war against terrorism particularly in reference of psychological trauma in district of Swat. Psychological trauma is defined as an enduring Pakistan has witnessed an increment in violence during terrorism in swat valley for last 3 years. In this regard the data from conflict management reports more suicide attacks in these 3 years. Mortality rate among civilians, insurgents and armed forces are also increasing particularly in District of Swat. Furthermore, the frequent clashes among insurgents and government have devastating impact on the civilians of Swat valley and they exposed to danger and psychological trauma because of these operations. Consequently, they are not only suffering from physical pain but the sense of helplessness and psychological trauma is also damaging. Inevitable psychological trauma in the survivors of violence is caused by severe warfare, associated abuse of power, sense of helplessness, pain and severe losses. Conditions or experience of an event in which a person experiences a threat to life, bodily integrity and sanity, and in danger of mutilation and eradication. Though this current wave of terrorism in swat valley Pakistan causes acute or psychological disorders. Manifestation of such psychological disorders is diverse and affect the lives of survivors.
Trauma and related psychological disorders was historically observed in 19th century. Impact of trauma can vary from individual to individual. Similarly, the manifestation of symptoms can be varied because of interpersonal or social issues, physical or behavioral problems, symptoms of psychological disorders and substance abuse. Survivors of trauma can develop range of psychological problems which need immediate psychiatric help. Contrarily, some of them show effective resilience to cope with traumatic situations and early intervention is needed for majority of trauma victims.
Now what’s about the health care response to trauma victims in relation with long term and short-term cope with psychological trauma. So, for the purpose it’s important to learn from literature to know about the strategies to help through psychological first aid and to develop a comprehensive treatment plan.In order to establish a potential link of after effects of psychological problems, studies from three countries Afghanistan, Sri Lanka and Algeria similar situations having were carried out. Results from these studies showed that prevalence rate of stigmatization, anxiety, depression and post-traumatic stress disorder is higher among survivors. Further deterioration was observed in social and ethical values confirmed by increased incidents of child abuse, drug and alcohol abuse, crime, violence against women, relationship problems, and brutalization among affected individuals.It is also shown that the impact is wide ranged encircling individuals, families and even communities as well. Findings of studies in this review suggested key factor which is response of mental health services. Findings suggested that the ratio of mental health services in response to psychological issues is not up to the mark, mental health services lack in resource provision in their facilities, non-availability of trained professional staff and policy. Moreover, they also lack in psycho education, basic psychological skills training for community workers and poor coordination among governmental and non-governmental organization working for rehabs. These services are working in isolated and scattered pattern so, the system needs an effective social assistance and culturally adapted interventions for psychological issues.In fact, the emotional and psychological effects are considered normal human emotional reactions to traumatic events occurred during terrorism in swat valley and these reactions are unavoidable. Hence its crucial to identify effective and evidence based treatment strategies so that with the training and education of healthcare management it might be effective to prevent and deal with such traumatic events effectively.
For interventions, systematic review of studies was conducted in the areas where similar war like situations were existing as in Pakistan. So, the review explored evidence based interventions which might immediate, short and long term psychological interventions for treatment policy and service development. As a result, psychological first aid was identified that includes information or emergency services and provision of emotional support and meeting practical needs. In case of acute trauma Psychological Debriefing should be provided immediately after traumatic events. This enables the victims to express their emotional reactions in a supportive and safe environment in the presence of mental health professionals. Another part of this intervention is Critical Incident Stress Debriefing (CISD). It can be helpful in prevention of PTSD through enhancing the interconnection of neural networks. More on, Forward Psychiatry is essential for battle stress to enhance the capability of soldiers to achieve military goals. Similarly, it would be more friendly and effective for the civilian and it should be run by civilian mental health professional.
Furthermore, Crisis Intervention (CI) and CISD are important to lower the chances of morbidity of elevated risk population. CI and CISD are required to educate the survivors about the difference of normal and trauma related emotional reactions. With the help of this intervention victims of trauma could be referred for further assessment and trauma related counselling to enhance well being and to prevent PTSD development. Evidences suggested that chronic PTSD may increase the risk of self-harm and substance abuse.
For system based intervention, it is required to have collaboration among different governmental agencies, religious support groups, community based organizations and non-governmental organizations. So, a model of evidence based interventions has developed accord with international standards. Model includes community, families and ulema (religious leaders)as different agencies under the umbrella, to provide information and awareness, and provision of immediate psychological first aid. It also helps us to screen individuals for appropriate intervention, and update and education of mental health professional through workshops and training. Referral pathway of the model is composed of family members, ulema (religious leaders), school teachers and general practitioners to ensure effective coordination.
Consequently, still the health care lacks any proposed interventions. There is no plan to provide psychological trauma services neither security forces have any kind of such interventions. It is an immediate need for health care providers and policy makers to seriously consider the need or availability of interventions.Its also required a focal organization for managing human resource development and monitoring for adequately provision of services.