‘Allah has punished them,’ Mia Zaman says of the 12 men chained in concrete cells around a tree. ‘See, we are not crazy. Allah has made them crazy as a punishment.’ The men are not criminals. They are at Zaman’s family shrine near Jalalabad, eastern Afghanistan, to be cured of mental illness.
Crouched in a cell nearby, a man covered in his own excrement begs for food and water and for his shackles to be released. He is too disturbed to answer any questions. Zaman, who is responsible for the patients, says he was brought by strangers and does not have a name. ‘He has been here eight days. After 40 nights, we will let him go,’ he explains. ‘God is great, he will cure him.’ Asked when the man’s cell, which smells unbearable, will be cleaned, he replies: ‘After the 40 days we will clean his place.’
The Mia Ali shrine is what passes for psychiatric treatment in Afghanistan, where there are fewer than 150 beds in a country of 32 million. According to the Ministry of Health in Kabul, more than half of the population suffer from mental health problems; the result of 30 years of war, mass unemployment, domestic violence and crippling poverty. Add to this illiteracy rates and access to healthcare that are among the lowest in the world, and most people are left to rely on traditional beliefs and often-dangerous medical practices to deal with mental afflictions.
The descendants of Mia Ali Sayed, a 17th century Sufi sage whose tomb lies in the shrine, have performed the same task for generations, earning their living from those who bring relatives to be cured. Treatment is simple: chain the patient up for 40 days. ‘We are in keeping with customs and traditions. We do not use medicines,’ says attendant Mia Shafillah. ‘They are given water, food and room to pray – they should be happy.’
Mohammed Khan, 60, is chained to a tamarisk tree. He doesn’t seem pleased with the service when his son calls the shrine to check his progress. ‘They are not letting me go from here. When can I go from here?’ he weeps down the phone. ‘I have got worse. When I came here there was a pain in my foot. Now it has extended to my back and there is even a pain in my head. It’s making me crazy… I’m your father: come and get me.’
His son, Rahmed Khan, says that he will fetch his father in a few days. ‘He has suffered mental problems since he was a child. When he was 25 years old he spent 40 days there and he became ok, so we brought him again,’ says Khan. ‘The shrine is very famous.’
Afghanistan has only one dedicated psychiatric hospital, in Kabul. It has beds for just 40 people with mental illness. Psychiatrist Feraidoon Ajam, who works there, says the hospital is over-stretched and does not have the budget to treat its patients properly. ‘People think their relatives are possessed by jinns or bad spirits. It is very difficult to tell them that it is a medical problem,’ he says, making his rounds of the dilapidated wards. ‘People are using local methods, such as going to these shrines or to their Mullah, instead of coming to hospital. By doing this they are only increasing their illnesses.’
Dr Alia Ibrahim-Zai, director of mental health at the Ministry of Health in Kabul, maintains that only education can change attitudes and prevent sites like Mia Ali being used. But progress is slow, she says. ‘Seventy-five per cent of mental health treatment is in primary healthcare. Our main challenge is funding to get to people in their communities. Unfortunately, donors are just not interested.’