A silent crisis in Afghanistan
Mental health challenges are becoming more common for children in Afghanistan, but one UNICEF-supported mental health clinic offers hope.
Today is Zahra’s* fourth counselling session. It’s still a long road to recovery, but the 16-year-old has made remarkable progress from the depressed and anxious girl she was a few months ago.
News of the March 2022 ban on girls’ secondary education hit Zahra hard. She was sad, isolated, and barely spoke to anyone at home. She could no longer see a future for herself without education.
“I felt like I could not be in this world anymore,” says Zahra. Her situation worsened every day, and she attempted to harm herself with any sharp objects she could get her hands on.
But luckily, Zahra was connected to Dr. Tayaba Hamedi, a child psychiatrist at a child and adolescent mental health clinic near her home in northwest Afghanistan.
A mental health sanctuary for children
Dr. Hamedi is the only female child psychiatrist in Afghanistan. She says there are many children in a similar situation as Zahra.
“The most common causes of depression among adolescent girls who come to the centre are related to restrictions on education, forced marriage, domestic violence, and poverty. For adolescent boys, it is often linked to poverty and the pressure to provide for their families,” she explains.
Psychiatrists at the centre see 35 to 40 children every day. The children go through a few assessments, and their conditions are diagnosed so Dr. Hamedi and her colleagues can determine the appropriate treatment.
Dr. Hamedi helps children like Zahra identify and cope with the underlying causes of depression and anxiety, leading them to a place where they can feel hopeful and positive again.
“Sometimes during our assessments, we discover the child does not have a mental health disorder but is reacting to conflict between their parents due to economic hardships and other problems. In such cases, we bring in the parents for individual or group sessions,” adds Dr. Hamedi.
Zahra wants to be a doctor, but she doesn’t know if she will ever go back to school.
For now, the counselling sessions help her overcome her depression, while her mother and uncle keep her occupied at home with some reading and writing assignments.
Every morning, Zahra watches her younger sister go to school, wishing she could join her. But Zahra is also painfully aware that a similar fate awaits her sister when she reaches Grade 7, since high schools are still closed for girls in Afghanistan.
Poverty, violence, and humanitarian crisis exacerbate the risk of mental health conditions and psychosocial problems for children and adolescents.
According to the 2022-23 Afghanistan Multiple Indicator Cluster Survey (MICS), around 24 per cent of children between ages 5 and 17 struggle with anxiety, and 15 per cent struggle with depression.
Unfortunately, services which can address these mental health challenges are limited in Afghanistan. Many children are not as fortunate as Zahra and cannot access the support they need.
More child psychiatrists, more training required
This centre is the only one of its kind in all of Afghanistan. No other centre offers specialized mental health and psychosocial support for children and young people. UNICEF continues to support this centre with funding through USAID’s Bureau for Humanitarian Assistance (BHA) and the European Union.
For Zahra, the centre is a lifeline. But for other children, untreated mental health conditions can have a lifelong impact.
For the time being, Dr. Hamedi and her colleagues have salaries to continue identifying and counselling children in need. Dr. Hamedi also has the resources she needs to train teachers, community leaders, health workers, and birth registration officers to identify mental health problems among children and adolescents and refer them to her centre for treatment. The centre also developed training curriculum for psychiatrists and counsellors in public universities.
But Dr. Hamedi adds, “there is still a shortage of psychiatrists in the country who are specially trained to treat children and adolescents.”
"There is still a shortage of psychiatrists in the country who are specially trained to treat children and adolescents," says Dr. Hamedi.
She says that some of her patients come from as far as the capital city Kabul, which is over 700 kilometres away. Even though treatment at the centre is free, transport costs can be prohibitive, particularly for those who must make weekly visits for counselling sessions. Afghanistan needs more centres like this one, closer to the children and young people who need them.
As Zahra makes her way to becoming herself again, Dr. Hamedi wishes there were more centres offering specialist care like this one. Zahra’s mother continues to hope for peace of mind and a good education for all her five children.