Pakistan

On March 3 of this year a bomb blast at Abbas Town in Karachi spread terror in the area, leaving 47 dead and 135 injured. As I was driving home from my clinic that evening, my son called and told me that two bomb blasts took place just 3 miles away from our home. I rushed home first and thought about how deeply terrorism has penetrated our daily life. The global issue of terrorism is becoming a grave daily reality in Pakistan, and on that day it became my patients’ and my reality, too. My psychiatrist and psychologist colleagues and I visited Abbas Town in the aftermath. As we stood in front of a ruined building, we saw the horror of this incident. As people gathered around us and started sharing their stories, we realized the need for mental health support. We therefore organized a weekly mental health clinic in Abbas Town. Here, psychologists and psychiatrists worked with survivors individually and in groups, providing a space for survivors to share their experiences.

I spoke with a 24-year-old man from Abbas Town. He described the ordinary scene before the blast and the sense of shock that overcame him afterward: “At that place our whole group used to sit together daily…. I was standing there at the corner; children were playing there…. The blast occurred in front of me.... For 15–20 minutes I was unable to hear and see anything. There was too much smoke, and then I ran to the blast site. It was a strange atmosphere. My heart was beating extremely fast.... I held my heart.... I did not know what was happening.” He described the chaotic scene after the blast: fire and smoke, apartments and shops destroyed, belongings and people falling from buildings, people trying to save their loved ones’ lives. He struggled to create a narrative of what he saw. With anguish he recounted, “Children were crying…. The building collapsed, and it was like the end of the world. Many of those injured and killed were neighbors and friends.” Shock was followed by action, as he began to help other residents with the rescue effort. But the desperation and helplessness left a permanent imprint in his mind: “I cannot forget that 10-year-old child who fell down from the second floor of a building and died. When I close my eyes, he is coming in front of me. We could not save him or a lady who fell from the first floor and died. For two or three days I was unable to sleep; if I slept, I would get up shouting, ‘Pick him up, rescue him.’” The trauma left him both shaken and numb: “When I sit alone I feel sad and extremely anxious, my heart beats fast. When I walk I start falling and my blood pressure drops. The whole day I do not feel hungry or thirsty…. Sometimes I feel as if life is going out of my body and my breath is stopping.”

As he recounted his horror and sadness, I recalled the memory of mass murder, of air filled with smoke and blood, and felt anguish in my heart. My reaction felt natural. This incident was beyond human endurance. Anyone witnessing such an incident would be affected by it. After conducting a group session, my heart filled with deep sorrow and anger about this brutal act of terrorism. The young man’s sentence echoed in my mind: “I have picked up meat with my hands. I cannot eat meat anymore.” I reflected on my own anger: “If terrorist organizations think they are fighting a war, then with whom are they fighting? With unarmed innocent children, women, and men? They are cowards who ambush secretly and turn a public place into a butcher house where guns and bombs cut life into pieces.” I experience the same anger and helplessness as my patients. I sometimes think about leaving Pakistan, not for myself but to protect my children. But then I think about the millions of children who live in Pakistan. Terrorism does not affect only me or my family. It affects the whole of Pakistani society.

But as I walked through the bomb blast scene, in front of the damaged building where people were busy in their routine chores, I thought about the resilience of human beings. I thought about my role as a psychiatrist to nurture that resilience.