Still suffering, five years after

In a tiny room where much of the space has been gobbled up by a steel cupboard, a bed and a sewing machine, Ayeshabibi Pathan sits on the floor, reminiscing about the dhamaal of five years ago, and the instant in which her life changed forever. "A bullet killed my husband," she says. "We don't know if the police fired at him, or if the mob did. The mob had all kinds of weapons, and the atmosphere then was such that you didn't know who was doing what."

In the statistics put out by the Gujarat Government, Ayeshabibi's husband is just another number that adds up to what activists say is an understated figure of over 1,000 people killed in the riots of 2002 (a majority of them Muslims). In her household in Faisal Park, Ahmedabad, located in a neighbourhood where riot victims have been rehabilitated by a non-government agency, his death is an immeasurable, palpable loss, and grief a shadow persistently knocking at the door.

Ayeshabibi was a resident of Naroda, where over 80 people were killed in a horrific massacre during the riots. Her own house was looted and burnt. With her children, she sought refuge in the Shah Alam relief camp and eventually moved to her current house. Trying to pick up the threads of an earlier life, she sent her children to a school nearby. But her daughter Tahira wasn't interested in her studies. "She had studied till the seventh standard in a municipal school in Naroda. She was very bright, a good student. But after the dhamaal, she failed in her exams," says Ayeshabibi. Tahira couldn't pass the tests in the new school either, though she attended classes for two years. "She says she doesn't want to study," says the distraught mother, adding as an afterthought, "She keeps remembering her father." Ayeshabibi's 14-year-old son goes to a school in Raigarh. "We didn't want to send him outside," she says. "But he didn't want to study here. Even now, he tells me that he will never come back to Ahmedabad."

Five years have passed after the riots, five years in which saplings have become trees and blueprints have taken the shape of buildings. But time seems to have stopped for many like Ayeshabibi and her children, for whom a monstrous yesterday has become an inextricable part of their today and tomorrow, altering their dreams and hopes in unlikely, distressing ways. Children and adolescents, many of whom suffered or witnessed atrocities during the riots, continue to live in an environment of insecurity and fear that appears to be subtly nurtured by the Gujarat Government, whose complicity in the communal violence is an established fact.

Most of the riot victims live in poverty, and while deprivation is visible, their pain and sorrows seem to have had a more intangible but real impact on their mental health. According to a study on Post-Traumatic Stress Disorder (PTSD; also see box) in children and adolescents affected by the communal violence, conducted in February 2006 by mental health professionals belonging to the Psychiatry Department of B J Medical College and Civil Hospital, Ahmedabad, close to five percent of the 255 interviewed showed signs of the disorder even four years after the riots; 9.4 per cent suffered from depression.

Dr Girish Banwari, co-author of the study and resident doctor at the Civil Hospital, says that most of the children and adolescents interviewed — from Ahmedabad, Mehsana, Vadodara, Anand, Panchmahal and Sabarkantha — had lost their fathers; their mothers did semi-skilled work or were homemakers. Hundred and ninety eight of those interviewed were Muslims; the rest comprised Hindus. Over 65 percent hailed from families whose monthly incomes were less than Rs.1,000.

"We saw most traces of that time in adolescents," says Banwari. "They definitely miss their fathers, they feel their lives would have been different — and better — if their fathers had been there." Many are afraid that something terrible could happen again. "A few children said that even a cracker bursting at Diwali made them afraid. Besides, in Ahmedabad, indeed in all of Gujarat, small issues that take communal overtones keep cropping up all the time," Banwari adds.

The genesis of the study in itself points to a problem that has up till now been more or less ignored. According to Dr G K Vankar, head of the psychiatry department at the Civil Hospital and the principal author of the study, the research was done on the request of the non-government organisation Self Employed Women's Association (SEWA). The organisation's staff, who works with the riot-affected, felt that several children had become "rebellious", says Vankar. "The children were not obeying their mothers, they were not studying," he adds.

Samina Ghotlawala, health coordinator at SEWA, which has been working with riot-affected widows in Gomptipur, Juhapura, Vatva, Bapu Nagar and Danilimda areas in Ahmedabad, says that the organisation has been providing the women with counselling services and making them independent. While there had been a marked improvement amongst those SEWA worked with, a few of the children seemed to have certain problems. "Some were good students earlier but are not studying well now. Some children have started stealing things, some don't want to study at all," she says. The study was an attempt to trace whether the riots had caused the behavioural changes.

Whose Gujarat? Mental health care needs help

The diagnosis of mental health problems, though much neglected, is important because these could affect the quality of life, and studies, says Vankar. In fact, while PTSD itself was identified only in a certain percentage of those interviewed, many exhibited some symptoms of the disorder. Explains Vankar, "To make a psychiatric diagnosis, there are a specified number of symptoms that have to be present for a certain amount of time, there has to be an impairment of functions. We have seen a number a manifestations that fall short of a diagnosis, which means the person hasn't reached the threshold to call it an illness." At the same time, this does not mean that the child or adolescent doesn't have any symptom of a mental-health problem. Of the 255 interviewed, 50 showed some symptoms of the disorder. Though they were not diagnosed with PTSD, they did require the help of mental health professionals, says Banwari.

Dr K Sekar of the National Institute of Mental Health and Neuro-Sciences (NIMHANS), Bangalore, says that a study conducted soon after the riots in 2002 showed that except for three percent, the riots had an impact on all the 100 children interviewed in the relief camps at Shah Alam and Dariya Khan Ghummat. Many girls had been sexually assaulted; the boys didn't want to go back to their homes where they had been manhandled by rioters.

Many children say they don't go back to school because their parents, or they themselves, are afraid and feel unsafe. Sekar remembers a girl who was six years old at that time. Troubled by nightmares, she couldn't sleep and would keep screaming in the night, shouting that a mob was coming to kill her. "When we started working with the child, we asked her to draw, and she drew one person with many hands, and trishuls in each hand. We asked her to explain the drawing and she said, 'I can only see one person in the front but in the back there are many people these are their hands when they are coming to kill us'," says Sekar. He also recalls an adolescent boy who had suffered 78 percent burn injuries. "He wouldn't talk while recovering and when he did, the first thing he said was that if he could get back on his feet, he would kill the people who had done this to him," he adds.

All these are normal reactions to an abnormal situation, says Sekar. "There is anger, people pace up and down, there is psychological distress, some have guilt at not having been able to save others in the family, memories occur even though they don't want to think about it," he explains.

The NIMHANS team's mental health intervention centred around identifying survivors who were willing to work as community-level volunteers through non-government organisations, in 13 riot-affected districts. "We held a capacity building training programme on psycho-social welfare for them," says Sekar. "Since we couldn't train a large number of people, we held a programme to train people who could train others." After the training programme, the volunteers were given specific tasks and asked to work with 50 families in their locality, and intensively with 25 of those 50 families. The volunteers used different strategies to help people cope with their loss.

"The trauma of each and every person is different but we used simple mechanisms such as allowing people to ventilate their problems, listening to what they had to say and creating social support, and teaching them relaxation techniques," says Sekar. Along with these, compensation, housing and para-legal issues were taken up so that the work wouldn't have just one focus. "What we realised from our earlier work in Orissa with the cyclone-affected was that when the volunteers visited, people complained that they [the volunteers] were making them cry by talking to them. Therefore, in Gujarat, we combined mental health interventions with a more social spectrum, taking up education, livelihood and compensation issues," says Sekar. Altogether, about 2,000 counsellors were trained in psycho-socio welfare, and a large majority of the victims who were in relief camps at that time would have received this support, he adds.

Two years after the riots, the NIMHANS team did a study in different parts of Ahmedabad to compare the situation of those who had received counselling to those who didn't. "We found that the distress level was much less in areas where there had been intervention. In the other groups, the distress level and social disability were high," says Sekar. The only common factor was that members from both groups felt that the quality of their life outside their own community was low, indicating the policy of exclusion of Muslims that has become an unwritten credo for many in the Gujarati society.

Indeed, this is something that Muslim children, denied admission in several schools on account of their religion, cannot escape. This polarisation could lead to strengthening of stereotypes about the other, warns Vankar. Adds Banwari, "Many of the children were not expressing their feelings but some were bold enough to say that they hated the other. Their feelings were reinforced when certain incidents happened — for instance, a boy talked about how someone from his community had been killed by a person from the other community. It strengthened his own feelings of hatred."

Sekar is clear that communal harmony is essential to improving the current situation. He says, "There are some non-government organisations working on these issues, and they are successful too at an individual level. Some celebrate festivals together — for instance, a slogan coined was that 'Diwali main Ali hain aur Ramzan main Ram' (there is Ali in Diwali and Ram in Ramzan). We need to build on these things." Yet, in today's Gujarat, where even basic health facilities are not available in areas where riot victims have moved to, mental health remains a blurry dot in the horizon. Meanwhile, edged out by a majority of the society for reasons that they cannot even comprehend, many of the child victims of the Gujarat riots continue to live in insecurity and fear.