INSURGENCY AND MENTAL HEALTH 
BY 
S.K.ROY, IAS

In today’s world skyline dotted with regions bleeding from insurgency and terrorist activities, state of human mental health is a major concern. Terrorism is a form of violence. It is defined in various ways in different circumstances. But most widely accepted definition is that offered by the World Health organization [WHO]. It defines violence as intentional use of physical force, threatened or actual, against another person, group or community, that results in injury, death and psychological harm. It affects mental health of the people, especially in regions of conflicts. Violence extracts a huge price from people worldwide. Cost of violence can be highlighted in the following manner:

      Ø      Violence, including terrorism, claims over 1.6 million lives world wide each year

      Ø      ­Violence is among the leading causes of death for those aged 15-44 yrs [14% males

                & 7% females]

       Ø      ­Violence costs countries in billions of US $

       Ø      Mr R Sivard, an authority in conflict management, assessed that the 20th Century is

                one of the most violent era in the history of mankind.

        Ø      191 million people lost their lives in violence as assessed by the International Institute 

                 of Conflict Resolution in this century

        Ø      In 2003 alone, about 33 million people died in conflicts world wide

Although violence created by human beings is as old as the human civilization, any organized effort to study and quantify impact of conflict and violence on public heath particularly mental health of the population, started only in 1970s by the ICRC in the context of the humanitarian crisis in Biafra, Nigeria. Thereafter many studies and researches were conducted in this regard and today it is an area of concern for everybody, everywhere Mr J Leaning in his book on Humanitarian Crisis, identified three factors that have profound impact on public health:  

In the canvas of what is discussed above, if the situation in Tripura is analyzed, it would appear that the society confronts collective violence, a form of terrorism. It is perpetrated by a group of people to achieve so called political end. As a result, lives were lost; property got destroyed & pace of development retarded. ­We lost 977 lives between 1998 and June 2004. Of these, 202 were security personnel and rest are mostly civilians, not engaged in conflict. All the factors identified by Mr. J Leaning that have impact on mental health of the population characterize the situation that prevails here. Even though large-scale violence in Tripura is of comparatively recent origin, say from mid-1980s, but perhaps no study was undertaken to gather dependable data to suggest the impact of violence suffered by those who went through it and survived. Figures relating to people having suffered trauma as a result of conflict or violence are therefore also difficult to gather.

Impact of conflict on mental health of individuals, who go through it or even witness it, is influenced by several factors. Those who are victims of violent situations suffer psychological stress. Such stress may traumatize individuals. Trauma could be the result of living through violence or witnessing acts of violence or being directly inflicted by torture, rape, etc. Like individuals, the society and the community may also get traumatized if it happens to pass through violent situations on a sustained basis. Conditions prevailing presently or in the recent past in countries/regions like Rwanda Afghanistan, Iraq, Sudan, Gaza Strip and Chechnya may serve as good examples of situations where communities are suffering trauma as aftermath of continued violence. Recent spells of uprising in Gaza Strip led to death of at least 300 children aged below 14 years. Its effect on the family, relatives and friend of those killed is anybody’s guess. The whole society is traumatized.
In situations characterized by terrorism related violence, psychological stress can result from displacement-forced or voluntary, loss & grief, social isolation, loss of status and inability to adjust to new environment mainly. Of these factors, most dangerous is displacement, which is mostly internal, in conflict torn regions. People in very large numbers either move out to escape violence or is forced to leave. They have no place to hide. They are described as IDPs [internally displaced persons]. Very recent example is Sudan, where because of ethnic cleansing perpetrated by black Arabs against Darfurians who are non-black Arabs, 500,000 live in Darfurian region are threatened. The UN has described it as a human catastrophe. In the wake of large-scale displacement of people, they essentially suffer from hunger, malnutrition; lack of security, etc and each of these are jointly and severally responsible for psychological stress of killing proportions.

Manifestations of such stress can include:

§         Depression and chronic anxiety

§         Psychosomatic ailments-nightmares, hallucinations

§         Suicidal behavior

§         Intra-family conflict

§         Substance abuse as a coping mechanism

§         Obsessive thoughts of revenge coupled with militarized behaviour

§         Intolerance

From mental health point of view, population affected by violence can be divided into three groups (i) those with disabling psychiatric illness (ii) those with severe psychological reactions to trauma and (iii) those, forming the majority, who are able to adapt once peace and order is restored. The first two groups are in dire need of mental health care programmes for rehabilitation.
The big question is what can be done to correct the situation. Some of the steps that are perceived to be effective may be:
Taking political action to predict, prevent and respond swiftly & decisively when conflict occurs. It is possible when the State power is not partisan. But unfortunately, in most of the conflict situations, the State is a party.
ü      Obtaining more extensive information about conflicts and a better understanding of 
        conflicts. This may lead to better management and conflict resolution.
ü      Humanitarian response in mission mode, as the international community did in the civil 
        war torn breakaway regions of former Yugoslavia.
ü      Young people may be given exposure to mental health programmes right from the schools. 
        It would lead to better understanding of issues involve.
ü      As a part of post conflict rehabilitation,Counseling Support Services could be very useful. 
        But to derive maximum benefit, it would be desirable to put such services in position     everywhere without waiting for crisis to take place.