Handicap International experience in Afghanistan - CBM

• For all persons with sensorial impairments the greatest difficulties encountered are for working in thefield and riding a bicycle or an animal. This is partly due to the fact that women are not allowed to workoutside the house in remote rural areas.In contrast to the above, people having mental and intellectual 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 workingin the field and riding animals or bicycles. Less than 30% people with mental or intellectual impairmentand 50.0% persons affected by epilepsy/seizures are able to perform these tasks. Here again, it is highlylikely that the fact that a majority of persons in this category are females also has an impact; gender normsdetermine 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 indicate having high levels of mental distress, which could meananxiety, depression, trauma, stress, etc. A few studies have looked at this issue in particular for the overall.population 19 . Our objective in this section is to present an overview of what the mental health indicators looklike. However, in order to present a coherent picture of mental health of Afghans with disability we choseto ask questions focusing on a few categories that came up as being important after discussion with otherpartners, as well as pre-tests. There is, inevitably, an overlap between some forms of disability identified bythe screening, and certain queries of the health questionnaire.The following section reports the responses of persons with disabilities to questions dealing with mentaldistress. For clarity we have divided this analysis into 3 major fields:• Behavioural problems which consist of 2 main domains: isolation/withdrawal and violence;• Problems related to communication and interaction with others;• Depression and anxiety signs.Before presenting the findings, it is important to stress that all the questions regarding some psychologicalor social difficulty emphasised the lack of identifiable reason for the problem. This was important in order todifferentiate a temporary problem, linked to a specific event or incident, 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 showing signs of mentaldistress is much higher than the proportion of non-disabled showing the same signs in the recent past.Figure 9 clearly shows that the difference between persons with disability and non-disabled persons isconsiderable with regard to mental distress indicators. The items where the proportion of non-disabled ishighest are the ones linked to anxiety and depressive signs. An analysis by type of difficulty provides a betterunderstanding 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 in communicating, andanxiety or depression. All these items are examined below.19RASEKH Z., BAUER H.M., MANOS M.M., IACOPINO V. (1998) “Women Health and Human Rights in Afghanistan”, 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, SocialFunctioning, and Disability in Post-War Afghanistan”, 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 Following War and Repression in Eastern Afghanistan”, Journal of American Medical Association, no. 292, pp. 585-93.The Health Picture21