HEALTH TRAUMA OF DISPLACED KASHMIRIS
Dr. K L CHOWDHURY, MEDICAL DIRECTOR
SHRIYA BHAT MISSION HOSPITAL, JAMMU, INDIA

HISTORICAL PERSPECTIVE

  • IN THE MASS EXODUS THAT ENSUED, THEY FLED TO NEIGHBOURING JAMMU
  • THEY WERE HOUSED IN TEMPLE PREMISES, ANIMAL SHEDS, AND CAMPS PROVIDED WITH RAMSHACKLE TENTS AND MEAGRE LIVIG FACILITIES
  • OVER THE YEARS ONE-ROOM TENAMENTS REPLACED THE TENTS
  • MORE THAN HALF OF THEM HAVE BEEN LIVING AS REFUGEES IN AND AROUND JAMMU FOR THE LAST 15 YEARS WHILE OTHERS HAVE MOVED ON IN SEARCH OF SPACE, SHELTER, EDUCATION AND VOCATION
  • HEAT STROKES ALONE CLAIMED MORE THAN A THOUSAND LIVES IN THE FIRST SUMMER OF EXILE.
  • THE PRESENT STUDY RELATES TO THE HEALTH TRAUMA OF THIS EXILED POPULATION.

MULTI DIMENSIONAL NATURE OF THE PROBLEM : THE REFUGEE AND ETHNIC CLEANSING PROBLEM HAS SEVERAL ASPECTS:

  • HISTORICAL
  • POLITICAL AND STRATEGIC
  • SOCIAL AND CULTURAL
  • RELIGIOUS AND ECONOMIC
  • DEMOGRAPHIC
  • HUMAN RIGHTS
  • HEALTH TRAUMA AND SURVIVAL IN SHORT TERM
  • LONG TIME SURVIVAL

‘Exile is like being shipwrecked
Torn from your roots
Shorn of your identity
Thrown into destinations unknown.’
From ‘Of Gods, men and Militants’ by K L Chowdhury

A major segment of the displaced population has been living in refugee camps in and around Jammu in the most miserable and hostile conditions, which have been described variously as ‘subhuman’ and ‘not worth living even for animals’

  • CROWDED LIVING CONDITIONS
  • FAMILIES WHO LOST ONE OR MORE MEMBERS TO TERRORIST KILLINGS
  • HOUSES TORCHED & · COMMERCIAL ESTABLISHMENTS TORCHED
  • UNEMPLOYED YOUTH WITH ADVANCED QUALIFICATIONS

MANIFESTATIONS OF DISEASE

Common and uncommon diseases, new syndromes and unique and bizarre constellation of signs and symptoms, have all surfaced giving rise to a wide array of psychological syndromes and mental and physical disease. Hardly any system in the body is unaffected. Death, natural and unnatural, has been hounding the community.

STRESS SYNDROMES

  • CARDIO-VASCULAR STRESS – HYPERTENSION, CORONARY ARTERY DISEASE – ANGINA AND HEART ATTACKS
  • PSYCHO-TRAUMA – ‘THE SYNDROME OF THE EXILES’, ANXIETY DISORDERS, PANIC ATTACKS AND DEPRESSION, SLEEP DISORDERS
  • ENDOCRINE STRESS – STRESS DIABETES, THYROID DISORDERS, OVARIAN FAILURE LEADING TO PREMATURE MENOPAUSE
  • MUSCULO-SKELETAL STRESS – REHUMATOLOGICAL DISORDERS, FROZEN SHOULDERS, ARTHRITIS, MUSCLE CRAMPS, RESTLESSLEG SYNDROME
  • STRESS BELLY- ULCERS, NON-ULCER DYSPEPSIA, ‘MIGRANT BELLY SYNDROME’, AND IRRITABLE BOWEL SYNDROME ETC.
  • CRANIAL STRESS - TENSION HEADACHES AND MIGRAINES

ENVIRONMENTAL DISORDERS

The trauma of forced exodus and the exposure to an alien and hostile environment with its new challenges to life and existence is further compounded by the problems of acclimatisation,
lack of basic amenities like living space, drinking water, drainage, and sewerage,
overcrowding, new antigenic exposure, extremes of climate, predator attacks etc.

  • HEAT-RELATED SYNDROMES – HEAT STROKES, HEAT EXHAUSTION
  • PARASITES – MALARIA - FREQUENT IN SUMMER AND FALL, DENGUE FEVER IN FALL - TWO EPIDEMICS
  • AIR BORNE DISEASES – ALLERGIC SYNDROMES - ASTHMA, HAY FEVER, DERMATITIS
  • SKIN INFESTATIONS – SCABIES, FUNGAL INFECTIONS, BOILS AND
  • WATER BORNE DISEASES - DIARRHOEA, DYSENTERY - ENDEMIC AMOEBIASIS, GIARDIASIS – ENDEMIC TYPHOID – ENDEMIC AS WELL AS EPIDEMIC VIRAL HEPATITIS – ENDEMIC AND EPIDEMIC
  • PREDATOR ATTACKS – SNAKE BITES, SCORPION BITES, RABIES
  • MISCELLANEOUS - KIDNEY STONES, RENAL INFECTIONS

NUTRITIONAL SYNDROMES LIKE

  • ANAEMIA, OSTEOMALACIA, MALNUTRITION, CACHEXIA (WASTING DISEASE OF THE EXILES), OBESITY
  • MAJOR EPIDEMIC OUTBREAKS - TYPHOID, DENGUE , HEPATITIS E , MULTIDRUG RESISTENT TYPHOID
  • SKIN DISEASES, PSYCHIATRIC DISORDERS
  • NUTRITION SYNDROMES, ALLERGIC SYNDROMES, ASTHMA, HAYFEVER
  • ULCER DYSPEPSIA, HYPERTENSION, STRESS DIABETES, OVARIAN FAILURE, INFECTIOUS DISEASES,
    RENAL STONES, RENAL FAILURE, TUBERCULOSIS

DISCUSSION

THE WHOLE WORLD KNOWS OF THE TERROR AND VIOLENCE THAT HAS ENGULFED KASHMIR DURING THE LAST 15 YEARS. NOT MANY ARE AWARE OF THE HUMAN TRAGEDY OF A DISTINCT ETHNO-RELIGIOUS GROUP OF KASHMIR KNOWN AS THE KASHMIRI PANDITS. THEY ARE THE INDIGENOUS PEOPLE OF KASHMIR WITH A HISTORY AND HABITATION OF MORE THAN FIVE THOUSAND YEARS IN THE VALLEY. ALMOST THE ENTIRE POPULATION HAS BEEN FORCED INTO EXILE DUE TO TERRORISM AND RELIGIOUS BIGOTRY. THE RESIDUAL MEMBERS IN THE VALLEY ARE THE SUBJECTS OF RECURRING BRUTALITIES - THE CARNAGE OF SANGRAMPORA (1997), THE MASSACRE OF WANDHAMA (1998), AND THE HOLOCAUST OF NADIMARG (2003).WHEN THE WHOLE COMMUNITY IS DISPLACED AND THROWN INTO AN ALIEN AND HOSTILE ENVIRONMENT, AND UNDER THE CONDITIONS THAT PREVAIL IN A FORCED EXODUS, THE PHYSICAL, MENTAL, MORAL AND SPIRITUAL FUNCTIONING IS THROWN OUT OF GEAR RESULTING IN HEALTH TRAUMA OF THE MAGNITUDE NEVER KNOWN BEFORE

THE GENESIS OF HEALTH TRAUMA

Three main factors leading to health trauma:

  • ENVIRONMENTAL AND LIFE STYLE CHANGE IN EXILE, PROFOUND HEAT- RELATED MORBIDITY AND MORTALITY, SNAKE AND SCORPION BITES, EXPOSURE TO A NEW VARIETY OF MICROBES AND PARASITES, NEW ANTIGENIC CHALLENGES FROM THE ENVIRONMENT
  • SUBHUMAN LIFE IN EXILE, SIEGE-LIKE CONDITION IN THE CAMPS WITH OVERCROWDING, LACK OF PRIVACY, INSECURITY, DENIAL OF BASIC AMENITIES OF WATER, ELECTRICITY, SANITATION, MALNUTRITION LEADING TO DIMINISHED IMMUNITY
  • STRUGGLE FOR SURVIVAL, NOMADIC EXISTENCE, FREQUENT CHANGE OF RESIDENCE, JOB HUNTING AND FREQUENT TRAVEL

CHANGING DISEASE TRENDS

· There is a changing trend in the disease manifestations over the years.
· During the ‘acute phase’, soon after exodus from the valley of Kashmir, almost every refugee suffered from one or more of the physical and psychological syndromes. Depression was rampant, skin diseases afflicted everyone, heat related diseases caught up with the advancing first summer of exile and heat strokes killed more than a thousand in the first year alone. A personality syndrome surfaced in the displaced people.
· The ‘phase of transition’ followed in the next 2-3 years as the coping mechanisms came into play, and while some of the acute problems started subsiding others took over – stress diabetes, allergic syndromes, hypertension and coronary heart disease, gastrointestinal ulcers etc.
Presently the exiled people are in the third phase, the ‘phase of consolidation’, with the firm establishment of disease entities that come with unmitigated stress and prolonged residence in an alien place. While hypertension and diabetes have come to stay and cause immense morbidity other endocrine diseases of the thyroid (Hypothyroidism) and the ovaries (premature menopause) have made their appearance in a big way. Depression is still a major problem. The endemic infestations of the host city have taken roots in the exiled community like giardiasis, amoebiasis, malaria, dengue fever, hepatitis etc

DECLINING POPULATION OF DISPLACED KASHMIRI PANDITS

HIGH DEATH RATE

· PREMATURE AGEING AND PREMATURE DEATH
· UNNATURAL DEATH
· HIGH INCIDENCE OF SERIOUS AND POTENTIALLY FATAL DISEASE
· AFFLICTION WITH MULTIPLE DISEASE SYNDROMES
· POOR MEDICAL AID
· ECONOMIC BANKRUPTCY
· DEPRESSION RESULTING IN LACK OF DESIRE TO LIVE

LOW BIRTH RATE

• LATE MARRIAGE, LATE CONCEPTION
• PREMATURE MENOPAUSE AND REDUCED FERTILITY SPAN DIMINISHED LIBIDO AND HYPO-SEXUALITY OF EXILE STRESS AND HORMONAL CHANGES THEREOF
• FORCED CELIBACY AND SEXUAL DEPRIVATION
• CONTRACEPTION AND ELECTIVE ABORTION
HIGH DIVORCE RATE

THE ECONOMIC BURDEN OF DISEASE

Monthly monetary relief per head - Rs. 600 (A$ 25)

Average treatment costs per month:

Minor surgery – Rs.3000-4000 ($125)
Major surgery – Rs. 20,000 to 40,000($700)
Delivery - Rs. 7000-10000($300)

Diabetic patient- Rs.2000 ($80)
Hypertensive patient - Rs.500-700 ($30)
Cardiac patient – Rs. 1000-1700($70)
Asthmatic – Rs.700-1000 ($35)

MEETING THE CHALLENGE

Life, which has gone out, can never be brought back.
Physical wounds heal, often leaving scars behind.
Mental trauma recovers but slowly, yet surfaces again and again.
The bruised spirit craves a divine touch.

No amount of intervention will ever restore the health of exiled Pandits short of return to their homeland.
The memory of genocide and ethnic cleansing will haunt them and revisit them for generations.
Yet the inexorable tide of suffering, disease and death will have to be stopped to reverse the trend towards the extinction of this distinct, though small, ethno-religious community with a history of more than 5000 years habitation in the valley of Kashmir.

This involves a multi-pronged effort at different levels of functioning outlined below, some of which are already in our focus:

  • CO-ORDINATE VARIOUS HEALTHCARE GROUPS WITHIN THE COMMUNITY.
  • EXPAND THE SCOPE OF VOLUNTARY HEALTH SERVICE TO CATER TO THE RISING NEEDS OF THE EXILED COMMUNITY
  • UPGRADE THE SHRIYA BHAT MISSION TO A FULL-FLEDGED MEDICAL FACILITY, A MEDICAL SCHOOL AND RESEARCH CENTRE.
  • CREATE A WORLDWIDE AWARENESS OF THE MAGNITUDE OF THE PROBLEM AND THE SPECTRE OF DISEASE, DEATH AND DWINDLING POPULATION
  • RED ALERT ON AN ENDANGERED HUMAN SPECIES - CALL THE ATTENTION OF DEMOGRAPHERS, SOCIAL SCIENTISTS, CONSERVATION GROUPS, HUMAN RIGHTS ORGANISATIONS, WHO, AND THE UNHRC FOR REFUGEES.
  • EMBARK ON HEALTH AWARENESS PROGRAMMES THROUGH SURVEYS, DISEASE-DETECTION DRIVES, SEMINARS, AND HEALTH CAMPS.
  • CREATE A FUND FOR MAJOR LIFESAVING HEALTH INTERVENTIONS
    LIKE PACEMAKER IMPLANTS, KIDNEY TRANSPLANTS, BYPASS SURGERY,
    CANCER THERAPY ETC.

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REFERENCES

•Chowdhury K L. Dengue fever in the exiled population. Daily Excelsior. 1993; 5th and 6th Nov. •Chowdhury KL. Health trauma of the displaced people - an overview. Kashmir Sentinel. 1994; 1:4Chowdhury K L. ‘Syndrome of the exiles’ – An evolving personality pattern. Kashmir Sentinel 1994; 1:6
Chowdhury KL. Stress Diabetes in exiles. Kashmir Sentinel. 1994; 1: 7.
•Chowdhury K L.. Premature menopause in Kashmiri exiles. Kashmir Sentinel. 1995; 2:3.•Chowdhury K L. Angina Pectoris (Coronary Heart Disease) in the Kashmiri refugees. Kashmir Sentinel. 1995; 2:5.•Chowdhury K L. Declining Population of Kashmiri Pandits in Exile. Koshur Samachar May 1996•Chowdhury K L.. Frozen shoulders in exiled Kashmiri Pandits. Koshur Samachar June 1996.•Chowdhury K L.. My Medical Journey through exile. A paper read at the Second world Kashmiri Pandit Conference 1998. New DelhiChowdhury K L. Health Trauma of Kashmiri Pandits in exile. A presentation in a 2-day conference on Kashmiri Pandits organised by ORF, 2003. New Delhi

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