A mental health emergency

The survey

Muntazar: Kashmir Mental Health Survey Report 2015 was conducted by Médecins Sans Frontières (New Delhi) with the University of Kashmir and the Institute of Mental Health and Neurosciences (IMHANS). Fieldwork ran from October to December 2015; the report was published in 2016.^[1]

Its method is why it carries weight. This is not a clinic caseload or a convenience sample of people who sought treatment:

A population-based survey on that scale, run by an international medical organisation with a university partner, is the strongest kind of evidence available for a claim about a whole population.

The findings

A precision, because it is the kind of thing a careful reader will want: these are symptom-screening prevalences — “probable” depression, anxiety and PTSD as identified by screening instruments — not individually confirmed clinical diagnoses. The survey says so itself, and this site uses its language. That does not weaken the finding. Screening prevalence at this level, in a population-based sample of 5,600 households, is what a public health emergency looks like in data.

For scale: a 19% probable-PTSD prevalence across an adult population is on the order of what is measured in populations that have lived through sustained armed conflict. It is roughly one adult in five.

What this file is doing in a human rights dossier

Every other file here counts events: people killed, blinded, tortured, detained, disappeared. Each is a discrete act with a date and, in principle, a perpetrator.

This file counts what those events did to everyone else. The 1,253 people blinded had families. The 8,000 to 10,000 disappeared left parents, wives and children — the half-widows of File 03 are among the people this survey counted. Every cordon-and-search operation passed through a village where children watched. Thirty-six years of that is what 45% measures.

It also answers a specific argument. The case for emergency powers is that they are a regrettable, temporary, proportionate response to a security threat. A survey finding that nearly half the adult population of the valley shows symptoms of significant psychological distress is evidence about proportionality — and it is the evidence the UN experts pointed to in a different form when they warned that excessive counter-terrorism measures “counter-productively fuel social division and grievances that can spiral into further violence.”^[2]

Capacity

The Kashmir Valley has a small number of psychiatrists relative to a population of this size and this level of measured distress, concentrated in Srinagar. IMHANS, the survey’s institutional partner, is the region’s principal mental health institution. A population of 1.8 million distressed adults cannot be treated by the services that exist, and the communications shutdowns documented in File 08 removed telemedicine as an alternative for months at a stretch.