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Afghanistan: beads of hope for mentally ill detainees

01-09-2011 Feature

For detainees in war-torn Afghanistan, conditions are tough at the best of times; those with a mental illness face even greater difficulties. Now, an ICRC programme is helping to break their isolation and give them a sense of self-worth. The ICRC’s Jessica Barry reports from Kabul.

Mentally ill detainees are often feared or despised. Many are abandoned by their families, cementing their emotional and physical exclusion. A programme offering handicrafts and beadwork might seem an unusual way to overcome such isolation. But it has done just that for 28 mentally ill detainees in Pul-i-Charki prison outside Kabul.

The programme is the brainchild of an ICRC detention doctor who started a pilot project four months ago in cooperation with the prison authorities, to provide the men with medical and psychological support.

The detainees – who have a range of mental disorders – are among a group of some 50 prisoners currently sharing a ground floor room in Afghanistan’s largest jail. Originally incarcerated in different cells, they were moved to their present location mainly because of their disruptive behaviour towards other prisoners. Some have been in Pul-i-Charki for up to ten years.

Wanted somewhere quiet

Living with them in their cavernous, musty-smelling room is a guardian, or cell leader, known as the Bashi. Mohammad Daoud, himself a detainee, is in good health. He volunteered for the job when the position became vacant eight months ago.

Asked why he took on such a challenge, Mr Daoud replies, "I could not stand the noise in the cell I was in upstairs, and I wanted to be somewhere quiet.”

Not that the prisoners in the ground floor cell are particularly silent. But he and they seem to have found a common sympathy, and the small, skinny man who sports a straggly beard and a traditional round Afghan hat has become a focal point in the 28 men's lives.

“I give them their food, wash the dishes and clean the floor,” explains Mr Daoud. As he spoke the men gathered round him, some smiling, some curious, and some obviously far away in their thoughts. “And I help them shave and shower,” he adds.

He also joins them when the men do their beading.

Array of handicrafts

In contrast to the drab, poorly lit cell where the men spend their days, the small cubicle where Mr Daoud keeps his things is bright with an array of handicrafts and beadwork the prisoners have made. These include red and white beaded flowers, garish coloured boxes and beadwork trinkets, hairclips and costume jewellery that the men store there before selling them to prison visitors. The money they earn allows them to buy cigarettes and other small items in the prison shop.

But the ICRC programme is not only about giving the men something to occupy their time.
A consultant psychiatrist assessed each detainee when the programme began, prescribed their medical treatment and makes follow up visits regularly. Twice a day a detainee doctor from the prison clinic gives the men their medication with the assistance of the Bashi. The men have also received mattresses, blankets and clothes from the ICRC, to help make their spartan living conditions a little more comfortable.

Dignity and self-respect

For Eva Gerber-Glur, the ICRC doctor who set up the programme, the venture is as much about giving the men back their dignity and self-respect, as it is about improving their health.

"The mentally challenged are the most vulnerable in any society," she says. "They don't have a voice of their own, but have just as much right to a dignified life as anyone else. That is why the ICRC approached the prison authorities and got their agreement to begin the pilot programme in Pul-i-Charki.

"The programme is also about changing attitudes towards mental health, and about respect for the mentally ill."

Improvements in the men's condition are already plain to see. "They are sleeping better," comments Mohammad Daoud, "they are less aggressive and more communicative than before."

Encouraging results

A first evaluation of the programme, done in June by the consultant psychiatrist, showed encouraging results. Today, three of the four prisoners who previously had to be restrained no longer need shackles.

Matiullah, who has spent six years in Pul-i-Charki, two of them in the mental ward, is one of them.

"Outside, I worked as a mason," he recalls. "I have been aggressive, even in here, but I feel some changes now. I like doing the handicrafts and it has made me interested in learning to write and do calligraphy. I would like to have notebooks and pens."

The detainee doctor who administers the men's daily medicine has also been quick to notice a change. "They are eating better," he says, "and even gaining weight." Speaking more personally he goes on, "In my eight years as a doctor before I myself was detained, I never had the experience that I have had here. I see changes in the men every day. It only needs someone to be kind and cooperative with them to make a difference."


Photos

Mohammad Daoud, the Bashi, or cell leader prepares his beads 

Mohammad Daoud, the Bashi, or cell leader prepares his beads
© ICRC / J. Barry

Beadwork requires patience and concentration, and can occupy the men for hours  

Beadwork requires patience and concentration, and can occupy the men for hours
© ICRC / J. Barry

The men sell their beaded flowers, costume jewellery and other trinkets to prison visitors 

The men sell their beaded flowers, costume jewellery and other trinkets to prison visitors
© ICRC / J. Barry