Handicap International experience in Afghanistan - CBM
Handicap International experience in Afghanistan - CBM
Handicap International experience in Afghanistan - CBM
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Figure 12: Distribution of Persons with Disability Hav<strong>in</strong>gCommunication Difficulties Accord<strong>in</strong>g to Ma<strong>in</strong> Types of Disability9080• Physical Disability • Sensorial Disability • Mental Disability• Associated Disability • Epilepsy/Seizures706050403020100Difficulty toRememberDifficulty toTalk to OthersDifficulty toUnderstand PeopleDifficulty toMake OneselfUnderstoodDifficulty toHear ClearlyDifficulty toSee ClearlyDepression and Anxiety SignsAfter more than two decades of conflict, anxiety and depression related disorders are widespread throughoutthe country’s population. Nevertheless, the correspond<strong>in</strong>g symptoms appear to be much more frequentamong the persons with disabilities. Ten items can be used to characterise these disorders: “want to staylocked up <strong>in</strong>side the house”, “feel very sad or cry without reason”, “do not feel hungry for long period oftime”, “feel afraid for no reason”, “sit for a long time th<strong>in</strong>k<strong>in</strong>g”, “want to live somewhere else”, “have rapidchanges of mood”, “feel oppressed for no reason”, “feel suffocated for no reason”, “feel angry and resentfulfor no reason”. In order to look at the signs, the surveyors were tra<strong>in</strong>ed to emphasise “for no reason” aftereach item.The existenceof anxiety anddepression signsis common <strong>in</strong>the populationof physicallydisabled andeven moreamong thesensorialcategoryFor each item, persons with sensorial or physical disabilities seem to show less signs of depression andanxiety. Yet, a significant proportion has the follow<strong>in</strong>g signs of depression: “feel<strong>in</strong>g sad/ cry<strong>in</strong>g without reason”(proportion of persons with sensorial and physical disability 25.0%), “sitt<strong>in</strong>g for a long time and th<strong>in</strong>k<strong>in</strong>g”(24.2% and 30.3% for the same), “feel<strong>in</strong>g oppressed without reason” (28.1% and 42.8%), and “feel<strong>in</strong>gsuffocated without reason” (32.3% and 42.8% respectively). The existence of anxiety and depression signs iscommon <strong>in</strong> the population of physically disabled and even more among the sensorial category. This suggeststhat not only the trauma of impairment and of its causes (war, accident, disease…) is highly affect<strong>in</strong>g themental health of these people, but also that hopelessness and frustration are probably tak<strong>in</strong>g their toll ontheir mental health.The situation is extremely worry<strong>in</strong>g for persons with mental disability, epilepsy and associated disability. Outof the ten symptoms, the proportion of persons with mental disability that have <strong>experience</strong>d them recentlyranges above 40% for all of them, and above 70% for half of them: “feel sad/cry” (74.6%), “sit and th<strong>in</strong>k”(79.4%), “feel<strong>in</strong>g oppressed” (72.6%), “feel<strong>in</strong>g suffocated” (77.8%), “feel<strong>in</strong>g angry and resentful” (69.8%).While family is the major value <strong>in</strong> the Afghan culture, more than half of the people with mental or <strong>in</strong>tellectualdisability would “like to live away from their family”, followed distantly by the proportion of people withassociated disability (29.1%) and people with epilepsy/seizures (21.5%). 6 out of 10 signs are present<strong>in</strong> more than half the proportion of people with epilepsy/seizures or with associated disability: respectively68.9% and 65.5% by “feel sad/cry”, 56.3% and 69.1% by “sit and th<strong>in</strong>k”, 66.7% and 63.0% by “rapidchanges of mood”, 51.1% and 65.5% by “feel<strong>in</strong>g oppressed”, 79.3% and 65.5% by “feel<strong>in</strong>g suffocated”,48.1% and 58.2% by “feel<strong>in</strong>g angry and resentful”. As for persons with epilepsy/seizures, these f<strong>in</strong>d<strong>in</strong>gsmay <strong>in</strong>dicate that a certa<strong>in</strong> portion of these may also present some additional mental problems such asdepression.24 Understand<strong>in</strong>g the Challenge Ahead