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On February 25, 2021, India and Pakistan reaffirmed their commitment to a ceasefire along the Line of Control (LoC) and all other sectors. This brought immense relief to the border communities, as the preceding period was marked by a high level of cross-border violence. This violence has significantly harmed the mental health of the border communities over the past two decades. Given this, the current interval of peace should be utilized to develop and shore up the mental health resources in the border areas by overcoming the challenges pertaining to the lack of infrastructure, minimal access to available facilities, and lack of personnel.
THE TIMING
The unrelenting nature of ceasefire violations (CFVs) from 2008 to 2021 has meant that the millions of people living along the border were affected and continue to be affected.
Every aspect of life, from education to employment to healthcare, was subject to interruptions. In contrast to the well-documented physical impact of casualties and fatalities to the civilians, the grave impact on the mental health of border communities is seldom focused upon.
After February 2021, the improvement in the situation along the border has resulted in the ability of the government to undertake developmental activities without interruption, ensuring better delivery of public goods, and increased civilian access to various resources (education, healthcare, and financial), amongst other benefits. This should be extended to mental healthcare as well—since deaths and injuries are more perceptible outcomes of cross-border violence, measures for physical safety (for example, bunker construction) take precedence over measures for safeguarding mental health.
THE CRISIS
Ceasefire violations have led to a spate of mental health issues. People experience fear, anxiety, confusion, panic, and stress, which have the potential to morph into long-term impacts like post-traumatic stress disorder and severe socio-occupational impairment. As per a 2015 study by Médecins Sans Frontières, Baramulla and Kupwara border districts in Kashmir reported a 51 percent and 58 percent prevalence of depression respectively. By contrast, non-border districts, such as Ganderbal, Srinagar, Anantnag, and Pulwama, reported lesser prevalence, between 28-38 percent.
Cross-border firing and shelling damages personal property, destroying sources of shelter and livelihood (farms for agriculture and livestock), adding to the mental health crisis. In a particular incident, civilians residing 1.5 km near the LoC reported being unable to sleep out of fear of the heavy exchange of gunfire. Particularly, the unpredictability of ceasefire violations causes significant stress. Due to home confinement (either because of CFVs themselves or resulting movement restrictions) or displacement from villages of residence, civilians are unable to access healthcare infrastructure during times of need.
Worse, the border region largely consists of rural areas, and the lack of healthcare facilities in these areas has been acknowledged by the government itself. As of 2022, hospital-level mental health services in Kashmir are primarily limited to two hospitals in Srinagar. This is a problem as 82 percent of Kashmir’s population lives outside Srinagar, as per the 2011 census.
Additionally, border areas see less healthcare professionals willing to serve in the region due to the prevailing violence. The shortage of human resources was acute enough for the state government to mandate doctors from border areas to serve in those areas for a minimum period of seven years. Where health facilities exist, their condition is poor, due to a lack of equipment, medicines, and medical specialists. A 2016 ActionAid study also noted stigma, lack of awareness, and unavailability of facilities as barriers to mental healthcare in Kashmir. After August 2019, telemedicine networks were disrupted as well. Due to the remoteness, harsh climate, and uneven terrain, border areas also suffer from access issues like the lack of roads and public transport. Security checks further delay treatment. These factors have meant that only 6.4 percent of those suffering from mental health issues across Kashmir have sought treatment for it, as per the ActionAid study.
Keeping the crisis in mind, the government must make effort to improve mental health infrastructure at the district level, ensure better access to available infrastructure, and incentivize health personnel and the private sector to serve in these areas.
THE WAY FORWARD
While the ceasefire in February 2021 has allowed the government to pursue development in the border areas with a renewed focus, a ceasefire violation in September 2022 served as a reminder that this peace is temporary and that cross-border violence can resume should relations between India and Pakistan dictate it so. This resumption would bring with it several negative impacts on mental health and healthcare of the border communities of Jammu & Kashmir. During periods of instability and high cross-border violence, the ability of the government to undertake any development is limited by the threat of violence. Thus, the time is right for the government to fill gaps in mental health infrastructure, access, and personnel. This capacity-building would not only address an immediate need along the border but also ensure medium- and long-term preparedness in the border areas if and when the violence returns.
The civilian administration and the army have undertaken physical healthcare initiatives in border regions, but mental health should be a priority for the state as well, particularly at a time when the overall development of the border region is being prioritized. For this purpose, the National Mental Health Programme and District Mental Health Programme serve as key guidelines, with their stated goals of capacity-building of healthcare professionals and infrastructure, spreading awareness, punctual diagnosis and treatment, data collection, and suicide prevention.
Lastly, while these challenges exist in other geographies to varying degrees, the reality is that mental health in conflict regions is more fragile and requires immediate attention. It requires localized, context-specific solutions geared to the border communities. Investment and effort here would serve as a force multiplier with knock-on effects on other aspects of life in the border areas, such as the economy. Thus, addressing mental health concerns is as critical to border welfare as, say, a highway or a power project.
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