The international community sees Nepal as a "nation in transition" where government, civil society and humanitarian organisations are striving to bring peace after a decade of war. A key part of peace-building is the provision of treatment for those mentally traumatised by the conflict, either directly as victims or perpetrators, or indirectly as witnesses.

Such treatment is essential in helping them to once again feel, think and behave appropriately within existing societal norms. It helps to stabilise patients' minds and allows them to focus on other significant needs of daily life, such as economic survival and education.

Since many of these patients have had direct experience of conflict, they often suffer from Post-Traumatic Stress Disorder (PTSD), various mood and adjustment disorders, schizophrenia and other psychotic problems.

For proper treatment, they need help from psychiatrists, clinical counsellors, psychologists and psychiatric social workers, who can offer them either medication or a range of therapies and counselling to help with their rehabilitation.
It is important to recognise that soldiers on both sides of the conflict, as well as police and many ordinary citizens have been struggling with these disorders at various levels of severity, sometimes for many years.

They may have developed a defence mechanism and become addicted to alcohol or drugs. If supporting organisations do not seriously address patients' mental health problems, there may be a significant increase in social problems such as suicide and homicide rates. An individual troubled by an unstable mind stands a greater chance of becoming homeless, suffering long-term depression and resorting to substance abuse.

The first pragmatic intervention could be to develop campaigns for awareness of and insights into mental illness in the Maoist cantonments, army and police barracks and communities living at the heart of the worst conflict areas. These campaigns could include psycho-educational programs such as street dramas, posters and visual documentaries to help people contemplate their mental health needs and feelings of security.

The next step could be to assess the need for formal mental healthcare. Once the individual cases and broad trends have been identified in the community, mental health professionals can try to create a therapeutic environment which allows the patients to vent their unresolved past issues.

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War trauma

Joona BK, 17, from Salle in Rukum district, was a Maoist fighter for seven months. During her time with the PLA she received political and weapons training. Most days she was out in the field.

The physical training was very rigorous and Joona used to fall sick quite often. There was never enough medicine. When she could not participate in activities due to her sickness, she used to get physically assaulted by her seniors and leaders of the group. "If I could not come for training, the leader used to beat me up and kick me until I would join the others," says Joona. She had been looking for a way to escape for a long time. When her mother fell sick, she was given permission to go home. She never returned.

Back at home, life was not easy. Joona's parents said that because she had joined the PLA her reputation was tarnished. People in her community said she was 'polluted' as she had lived with strange men in the army when she was away from home.

Joona still lives with her parents. The rigorous exercise routine and the beating from the leaders have left her physically injured with a severe stomach ulcer. But her psychosocial problems are more serious. She has flashbacks of some of the gruesome incidents she had to witness as a Maoist fighter. She is irritable, has no appetite, and says she feels lonely all the time. She still thinks the Maoists will come and take her back. Recently she swallowed poison in an attempt to kill herself.

Local doctors are treating her physical ailments. She also receives psychosocial support from professional counsellors, and after a few sessions has been making progress. Her relationship with the local community is improving, and she tells the counsellors she is feeling more positive and confident.

Divya Malla, 20, works at a stone quarry in Dhading. She left school because her family needed help earning enough money to feed them all. Shortly after she left school, she witnessed a close friend, Maya Devi, being gang-raped by boys from a neighbouring village. When news of the rape spread, the victim's mother accused Divya of spreading false rumours.

A few days later Divya was gathering firewood when some Maoist women seized her. For two weeks they beat her and made her do difficult physical work. They threatened to kill her if she would not join their group.

The five months she spent with the Maoist fighters were difficult. She had to gather firewood, plant rice, carry bricks to build roads and cook food. When she told them she wanted to go home they beat her again.

There were no separate rooms for men and women, so all the fighters slept together. She witnessed many of the women being molested and raped by male fighters. Luckily, Divya's father pleaded with the group leader to let her go. By that time Divya had become so sick that the leader said she was of no use to them anyway. Back home people ostracised her her. Divya was called a 'loose' woman and not allowed to participate in public ceremonies. She tried to go back to school, but the teasing got so unbearable that she could not step out of her house.

"I am sad most of the time, my head hurts," says Divya. She suffers from an inferiority complex and is restless. Her sister says Divya has no appetite and spends her time alone, staring into space, too distracted to finish the housework.

Divya says: "Every time I see a bunch of women coming towards me, I think they are coming for me. If they take me now I know they will kill me."

Source: Transcultural Psychosocial Organisation (TPO Nepal)