Psychological Welfare

Armenian International Magazine AIM Vol. 11, No. 1, January 2000, pp. 64-66.

Psychological Welfare
Healing the Emotional Scars of the Karabakh War


"Every child and adult in Karabakh has a war story,” says Khatchatur Khachik Gasparian, 36, psychologist and head of the Yerevan State Medical University’s Medical Psychology Section. “The need to listen to them is enormous and essential,” he adds.

Much has been written about the political, military and economic implications of the devastating war in Karabakh, especially from 1991 to 1994. But very little attention is given to the long-term psychological effects of the war on the general population and, especially, children.

A 1997 study, conducted by a team of professionals headed by Gasparian, which surveyed a randomly chosen sample of 158 adults, showed that 80 percent had been affected by the consequences of grief because of loss of family members. The study found some 226 cases of fear among the surveyed group (most of them having multiple fears), and 198 different psychosomatic symptoms. Gasparian indicates that most children in Karabakh are fearful of losing their fathers and are very scared that the war will start again.

“Traumatic events in Karabakh over the last 10 years are now causing somatic reactions,” says Gasparian.

“For example, there is an increase in diabetes among children; there are also cardiological and cardiovascular complications. These are direct results of fears and anxieties,” he explains.
According to Gasparian, the worst psychological affect of the war is on family relations. “The war changed the population’s family structure,” he says. “The role and responsibility of the missing member of the family, for example the father, has fallen on the others — either the mother or the children. Women who have lost their husbands project their problems on their relationships with their children. There are many instances where mothers expect their young sons to fulfill the role of the husband in domestic chores. It is not uncommon to see boys four and five years old cutting wood for winter or doing the ‘male jobs’ around the house.”

As in the case of all societies at war, there is “war fatigue and combat trauma.” People are tired of fighting for years and not knowing when it will end. “Most people do not have any certainty about the future,” says Gasparian, adding that this could have long-term implications for Karabakh’s society.
He explains that over time post-traumatic syndromes turn into somatic diseases, which “are on the increase” in Karabakh. Indeed, Gasparian believes that there is a need to create various special programs to deal with such issues, especially the problems of soldiers.

“Psychological intervention in traumatic cases could greatly reduce effects on the physical health of the people,” says Gasparian, who in 1995 received an eight-month fellowship at the International Development Center at the Queen Elizabeth College in Oxford, England.

Gasparian had been working in Karabakh since 1992 implementing various psychological treatment projects. In 1994, he initiated a program with Doctors Without Borders (known by its French abbreviation, MSF: Medicins Sans Frontieres) and became director of a psychological center in Stepanakert set up MSF — the international non-governmental organization, which in 1999 won the Nobel Peace Prize. Gasparian and a team of psychologists treated more than 300 children and 150 adults right after the bombings in Stepanakert.

Subsequent proposals for psychological intervention and training projects in Karabakh have been rejected. He mentions with disappointment that several Armenian organizations in the Diaspora did not even respond to his letters. International organizations do not easily fund projects in “unrecognized” countries. In fact, when Gasparian received an acknowledgment from the European Community Humanitarian Office (ECHO), they thanked him for his “humanitarian work in Azerbaijan.”
But Gasparian did not give up. When in 1996 MSF’s two-year grant ended, he helped continue the program with a few local Karabakh professionals using the modest infrastructure that was in place. In 1998, working with MSF Belgium, Gasparian was successful in creating a new Mental Health Project in Karabakh, funded by the USAID, through Save the Children. This was part of the $12.5 million US aid to Karabakh allocated by the US Congress for the fiscal year 1997. The grant will end in mid 2000. But permanent treatment and care facilities are sorely needed.

According to Gasparian, since 1994 over 1000 patients (among others, 657 suffering from schizophrenia, 266 from epilepsy) have been treated for psychological problems caused by the war. Not all of them have received adequate long-term treatment, since there is a lack of facilities, as well as human and financial resources.

Last summer, Gasparian organized a training program in Stepanakert where doctors from the Diaspora and Armenia — such as Lara Aharonian from Canada, Edmond Gergerian from New York, Dikran Nalbandian from Moscow and several from Yerevan — participated and provided useful material to local care providers. The training was coordinated by Marite Stephans, MSF Belgium’s resident coordinator in Karabakh, and Thierry Tavox, head of the MSF mission in Armenia.

But the future of psychological care and intervention in Karabakh is uncertain.

Gasparian, working with the Health Minister of Karabakh, Zoya Lazarian, and in consultation with Karabakh authorities, has been trying to establish a permanent psychological center. The authorities have given him all necessary help but funding is still a major problem. “It would take less than $100,000 to establish a state-of-the-art psychological center in Karabakh, which would also serve the regions,” says Gasparian, who has appealed to a few Armenian organizations in the Diaspora for funding. He’s keeping his fingers crossed.

“I cannot emphasize enough the importance of a center to treat people with psychological difficulties; short-term grants by international organizations do not provide adequate long-term solutions,” explains Gasparian. “We need to treat adults, especially war veterans, as well as children and others who have seen death up close. It’s the only way to help prevent an entire generation from losing hope in the future.”

[Drawing see PDF version]
An 8-year-old girl shows a wounded soldier with arm cut off, covered with blood, that she and her family saw in the woods while escaping from Martakert
to Stepanakert in 1992.

[Drawing see PDF version]

A 9-year-old girl drew a circus, explaining that children from all over the world are welcome to play there, except for children from Karabakh. In 1990, the girl and her family fled Baku for Martakert, then in 1992 they escaped to Stepanakert.

[Drawing see PDF version]

A girl shows fear of going back to her home in Martakert because there were Azerbaijani soldiers in the house when they escaped. She remembers Azerbaijani soldiers beating her father in their house in Baku. During a therapy session, the girl put the Azerbaijani
soldier in “prison” as a way to deal with her fear and anxiety.

[Drawing see PDF version]

The globe drawn by an 8-year-old boy showing Moscow, France, US, England, and France. When asked where is Karabakh, he said, “Karabakh is not on the map, no one cares about Karabakh.”

[Drawing see PDF version]

A 10-year-old Stepanakert boy’s self-image, and his fear of dead
bodies expressed through a coffin and a snake behind a cabinet door.

[Drawing see PDF version]

8-year-old girl projects fear through her mother's image.

Hratch Tchilingirian
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