Handicap International experience in Afghanistan - CBM
Handicap International experience in Afghanistan - CBM
Handicap International experience in Afghanistan - CBM
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• For all persons with sensorial impairments the greatest difficulties encountered are for work<strong>in</strong>g <strong>in</strong> thefield and rid<strong>in</strong>g a bicycle or an animal. This is partly due to the fact that women are not allowed to workoutside the house <strong>in</strong> remote rural areas.In contrast to the above, people hav<strong>in</strong>g mental and <strong>in</strong>tellectual disability, as well as the cases of epilepsy andother forms of seizures, are more able to perform duties outside the house, with the exception of work<strong>in</strong>g<strong>in</strong> the field and rid<strong>in</strong>g animals or bicycles. Less than 30% people with mental or <strong>in</strong>tellectual impairmentand 50.0% persons affected by epilepsy/seizures are able to perform these tasks. Here aga<strong>in</strong>, it is highlylikely that the fact that a majority of persons <strong>in</strong> this category are females also has an impact; gender normsdeterm<strong>in</strong>e which tasks are not to be carried out by women outside the house.Mental Health of Afghans with DisabilityIt is believed that a large number of Afghans <strong>in</strong>dicate hav<strong>in</strong>g high levels of mental distress, which could meananxiety, depression, trauma, stress, etc. A few studies have looked at this issue <strong>in</strong> particular for the overall.population 19 . Our objective <strong>in</strong> this section is to present an overview of what the mental health <strong>in</strong>dicators looklike. However, <strong>in</strong> order to present a coherent picture of mental health of Afghans with disability we choseto ask questions focus<strong>in</strong>g on a few categories that came up as be<strong>in</strong>g important after discussion with otherpartners, as well as pre-tests. There is, <strong>in</strong>evitably, an overlap between some forms of disability identified bythe screen<strong>in</strong>g, and certa<strong>in</strong> queries of the health questionnaire.The follow<strong>in</strong>g section reports the responses of persons with disabilities to questions deal<strong>in</strong>g with mentaldistress. For clarity we have divided this analysis <strong>in</strong>to 3 major fields:• Behavioural problems which consist of 2 ma<strong>in</strong> doma<strong>in</strong>s: isolation/withdrawal and violence;• Problems related to communication and <strong>in</strong>teraction with others;• Depression and anxiety signs.Before present<strong>in</strong>g the f<strong>in</strong>d<strong>in</strong>gs, it is important to stress that all the questions regard<strong>in</strong>g some psychologicalor social difficulty emphasised the lack of identifiable reason for the problem. This was important <strong>in</strong> order todifferentiate a temporary problem, l<strong>in</strong>ked to a specific event or <strong>in</strong>cident, as opposed to a recurrent or chronicproblem.Non-Disabled and Persons with DisabilityThe first affirmation that can be made is that the proportion of persons with disability show<strong>in</strong>g signs of mentaldistress is much higher than the proportion of non-disabled show<strong>in</strong>g the same signs <strong>in</strong> the recent past.Figure 9 clearly shows that the difference between persons with disability and non-disabled persons isconsiderable with regard to mental distress <strong>in</strong>dicators. The items where the proportion of non-disabled ishighest are the ones l<strong>in</strong>ked to anxiety and depressive signs. An analysis by type of difficulty provides a betterunderstand<strong>in</strong>g of the situation.Behavioural Problems: Isolation, Sadness, Fear and ViolenceThis part reports the responses of persons who suffer from behavioural problems such as isolation andwithdrawal from others, violent reaction to outside solicitations and pressure, difficulty <strong>in</strong> communicat<strong>in</strong>g, andanxiety or depression. All these items are exam<strong>in</strong>ed below.19RASEKH Z., BAUER H.M., MANOS M.M., IACOPINO V. (1998) “Women Health and Human Rights <strong>in</strong> <strong>Afghanistan</strong>”, Journal of AmericanMedical Association, 1998, no. 280, pp. 449-55.CARDOZO B.L., BILUKHA O.O., CRAWFORD C.A., SHAIKH I., WOLFE M.I., GERBER M.L., ANDERSON M. (2004), “Mental Health, SocialFunction<strong>in</strong>g, and Disability <strong>in</strong> Post-War <strong>Afghanistan</strong>”, Journal of American Medical Association, August 4, 2004; no. 292, pp. 575 - 84.SCHOLTE W.F. OLFF M., VENTEVOGEL P., VRIES (de) G. J., JANSVELD E., CARDOSO B.L., GOTWAY CRAWFORD C.A. (2004). “MentalHealth Symptoms Follow<strong>in</strong>g War and Repression <strong>in</strong> Eastern <strong>Afghanistan</strong>”, Journal of American Medical Association, no. 292, pp. 585-93.The Health Picture21