Journal of Loss and Trauma

International Perspectives on Stress & Coping

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Mental Health in the Face of Armed Conflict:

Experience from Young Adults of Kashmir

Aehsan Ahmad Dar & Sibnath Deb

To cite this article: Aehsan Ahmad Dar & Sibnath Deb (2020): Mental Health in the Face of
Armed Conflict: Experience from Young Adults of Kashmir, Journal of Loss and Trauma, DOI:
10.1080/15325024.2020.1739367

To link to this article: https://doi.org/10.1080/15325024.2020.1739367

Published online: 18 Mar 2020.

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JOURNAL OF LOSS AND TRAUMA
https://doi.org/10.1080/15325024.2020.1739367

Mental Health in the Face of Armed Conflict:

Experience from Young Adults of Kashmir
Aehsan Ahmad Dar and Sibnath Deb
Department of Applied Psychology, Pondicherry University, Puducherry, India

ABSTRACT ARTICLE HISTORY

The main aim of this qualitative study was to estimate the Received 19 January 2020
impact of armed conflict on mental health among young Accepted 3 March 2020
adults in Kashmir. A total of 680 undergraduate and post-
KEYWORDS
graduate students completed the semi-structured question-
Kashmir conflict; trauma;
naire covering areas like demographic information, perception violence; mental health:
about the Kashmir conflict, and its impact on health (mental psychological
and physical) and education. Results found that 99.7% of par- support services
ticipants reported exposure to conflict, 95.4 % experienced
psychological distress, 60.3% mentioned physical sickness, and
91.2% found others mental health being affected and 99.3%
expressed that their education was severely affected as a
result of the conflict in Kashmir. Given the potential negative
impact of conflict exposure, efforts are suggested in this direc-
tion to enhance the psychological support services to address
the mental health issues in this trauma-exposed population
of Kashmir.

Introduction
The division of the Indian subcontinent into two independent dominions
of India and Pakistan has heralded an era of the dispute over Kashmir
which dates back to 1947 (Bose, 2003; Ganguly, 1999). This dispute
remains a bone of contention between divided nations (Bose, 2003), over
which four major wars have been fought (Ganguly et al. 2019). Currently,
Kashmir remains divided into three parts each governed by India, Pakistan,
and China, respectively (de Jong, Ford, et al., 2008). This division affects
over eight million Kashmiri people (Bhat & Rangaiah, 2015a). Until 1988,
the Kashmir dispute remained an interstate affair between Pakistan and
India, with the advent of liberation movement by Kashmiri militants in
1989 an armed insurgency started in Kashmir which resulted in a long
cycle of violence (de Jong, Ford, et al., 2008). Research has documented
that Kashmir becomes a battlefield between armed militants and Indian
troops at any point of time wherein civilian population is caught in

CONTACT Aehsan Ahmad Dar [email protected] Department of Applied Psychology, Pondicherry

University, R.V. Nagar, Kalapet, Puducherry 605014, India.
ß 2020 Taylor & Francis Group, LLC
2 A. AHMAD DAR AND S. DEB

between experiencing violence, injury (both physical and mental) and death
(Bhat & Rangaiah, 2015a; Dar, 2011; Wani & Margoob, 2006). For the last
30 years, Kashmir has been subject to the violence of armed conflict which
resulted in a death toll of over 100,000 people (Bhat, 2019) and enforced
disappearance of more than 10,000 individuals (Bhat, 2019; Mathur, 2016).
Further, over 7000 unmarked mass graves were identified in Kashmir.
Furthermore, in the year 2018, 586 killings were recorded which include
267 militants, 160 civilian people, and 159 armed forces and police person-
nel (Bhat, 2019).
No one is immune to violence in Kashmir. A community-based sur-
vey by Medicines Sans Frontieres (2015)1 disclosed that on average, an
adult in Kashmir has witnessed 7.7 traumatic events in the course of
her/his life. The traumatic events reported include crossfire, round-up
raids, torture, humiliation, forced labor, prolonged curfew, explosions,
killings, sexual violence, maltreatment, kidnapping, firing of teargas
shells and pellets (Bhat et al., 2017; Bhat & Rangaiah, 2015a, 2015b;
Dar, 2011; Deol & Ganai, 2018; Kaul, 2018; Mathur, 2016;
Rather, 2013).
The prolonged exposure to violence stifles an individual’s psychological
integrity and damages her/his sense of identity (Bhat & Rangaiah, 2015a:
Das, 2007). Before the armed insurgency broke out in Kashmir, the ratio
of people suffering from mental disorders was not different from its adja-
cent regions (Bhat & Rangaiah, 2015a; Yaswi & Haque, 2008). Since then
(1989) the number of mental disorders has increased drastically in this
part of the world. Hassan and Shafi (2012) reported that the number of
people attending the psychiatrists was 100 per week in the 1980s which
increased to 200 to 300 per day in 2012. In a recent article, Bhat and
Khan (2018) disclosed that in 1989, 1700 people attended the hospital for
mental health issues, which increased to 100,000 people in the year 2017.
Research has reported a range of mental disorders among the people of
Kashmir due to ongoing armed conflict such as anxiety (Housen et al.,
2017), depression (Khan et al., 2014), post-traumatic stress disorder (Bhat
& Rangaiah, 2015b; Khan et al., 2014) suicide (Ara & Ahad, 2016; de
Jong, van de Kam, et al., 2008), obsessive-compulsive disorder (Dar et al.,
2015), somatoform disorders (Khan et al., 2014), adjustment disorder
(Chadda et al., 2007), insecurity (de Jong, van de Kam, et al., 2008), anger
(Hassan et al., 2019), panic disorder (Dar et al., 2015) and substance abuse
(Wani & Singh, 2017). This study is part of a larger effort to estimate the
impact of prolonged armed conflict in Kashmir on the mental health of
young adult students. In this article, we report the perception of Kashmir
conflict and its impact on health and education of Kashmiri students
exposed to the conflict.
 JOURNAL OF LOSS AND TRAUMA 3

Methods
Participants
Participants included 680 young adult students (male ¼ 457 and female ¼
223). The sample was drawn from 19 colleges and 3 university campuses of
Kashmir Valley by using a multi-stage sampling technique. The data collec-
tion was carried out between, October 2018 to January 2019. The partici-
pants were recruited in two stages which are as follows:
Stage I: A list of colleges was prepared district wise by the researchers and 2 colleges
were randomly taken from each district. There are 10 districts in Kashmir since one
district has only one college, the total number of colleges was 19. Three University
Campuses were also covered in recruiting the participants.

Stage II: Both undergraduate and postgraduate students were covered, irrespective of
their year of education in the same institution. Available students during the field
visit were recruited based on voluntary participation.

Procedure
The researcher obtained approval from the college and university author-
ities (College principals and University Deans/Directors) before starting the
process of data collection. After granting permission to carry out the data
collection from the respective authorities participants were approached.
Before taking part in the study, each participant was provided a copy of
the consent form and requested to sign on the same. They were briefed
about the study as well as their rights as study participants. The partici-
pants took 20–30 min to complete the questionnaires.

Ethical aspects
The participants were treated as per the ethical guidelines of APA/ICMR.
The current work was approved by the Pondicherry University. The
respondents were assured confidentiality of the information and their par-
ticipation was completely voluntary.

Measures
Semi-structured questionnaire
There are five sections in the semi-structured questionnaire on issues like
background information; relations with parents, family members, friends, and
teachers; perception about Kashmir problem and its impact on health (mental
and physical) and education; views about perceived solution of Kashmir prob-
lem and views about religion and media. Three experts in the field checked
4 A. AHMAD DAR AND S. DEB

the face validity of the semi-structured questionnaire. Based on their inputs, it

was revised. Further, it was subjected to the pilot study and was made minor
changes to make some of the questions simple and then it was finalized for
final data collection. For writing this paper, some items from sections I and III
were used. Given below is the description of each the two sections:
Section I: The section I has 9 items which include age, gender, monthly family
income, place of living and so on. For example, “What is your gender?”, “What is
your age?”, “Where do you live?”, “What is the monthly income of your family?”, and
so on. The responses for these items were recorded as “male” or “female,” “18–20
years” or “21–25 years,” “less than 20,000 INR” or “20,000 INR and above” and
“rural area” or “urban area.”

Section III: There are 12 items in section III covering areas like perception about the
Kashmir conflict and its impact on health (mental and physical) and education.
Some of the questions asked to participants include “Do you feel that there is violence
in Kashmir?”, “Do you feel psychologically distressed because of the present situation?”,
“Do you think that your education has been affected because of the present situation
in Kashmir?” and so on. The responses were recorded in the form of “yes” or “no.”
The dichotomous items were followed by open-ended items to record the qualitative
data, for example, “If yes, why did you say so … … .”

Analysis
Frequency and percentage were computed for the descriptive analysis of
the data to indicate the distribution of demographic variables. Content ana-
lysis was carried out for the analysis of qualitative data. The descriptive
analysis was carried out with the help of the SPSS 20.0 package.

Results
Demographic profile of the sample
A total of 680 young adult students participated in this study. Of the par-
ticipants, 305 (44.9%) were 18–20 years old and the remaining 375 (55.1%)
were 21–25 years old. Two-third of the respondents (67.2%) were male and
the rest 223 (32.8%) were female. The monthly family income of 423
(62.2%) respondents was less than INR 20,000 and that of 257 (37.8%) par-
ticipants were INR 20,000 and above. The majority of the respondents
(66%) came from rural areas and the remaining 231 (34%) hailed from
urban localities. Regarding the family type, 41.2% (28/680) came from joint
families and 58.8% (400/680) were from nuclear families. Concerning the
number of siblings, 28.1% (191/980) were a single child or had one sibling
and 71.9% (489/680) had two or more siblings. An overwhelming number
of the students (63.8%, 434/680) were undergraduate students and the rest
 JOURNAL OF LOSS AND TRAUMA 5

Table 1. Socio-demographic and background details of

the sample (n ¼ 680).
Variable n (%)
Age
18–20 years 305 (44.9)
21–25 years 375 (55.1)
Monthly income
Less than INR 20,000 423 (62.2)
INR 20,000 and above 257 (37.8)
Family Type
Joint 280 (41.2)
Nuclear 400 (58.8)
Educational level
Undergraduate 434 (63.8)
Postgraduate 246 (36.2)
Mothers’ occupation
Employed 65 (9.6)
House maker 615 (90.4)
Gender
Male 457 (67.2)
Female 223 (32.8)
Native place
Rural 449 (66.0)
Urban 231 (34.0)
No. of siblings
1 sibling or none 191 (28.1)
2 or more siblings 489 (71.9)
Fathers’ occupation
Employed 539 (79.3)
Unemployed 141 (20.7)

36.2% (246/680) were postgraduate students. Most of the fathers (539/680)

were employed whereas the majority of the mothers (615/680) were house
makers (Table 1).
Table 2 shows that all the students 99.7% (678/680) felt that there is vio-
lence in Kashmir except two. The majority of the students 95.4% (649/680)
reported feelings of psychological distress and a small portion of 4.6% (31/
680) did not feel the same. Nearly two-thirds of the students 60.3% (410/
680) reported physical sickness resulting from conflict violence and the rest
39.7% (270/680) were of the opposite views. An overwhelming number of
students 91.2% (620/680) reported that psychological diseases have been
developing among Kashmiri people because of the conflict of violence
whereas, one-tenth of the students 8.8% (60/680) did not share the same.
Close to cent percent of the students 99.3% (675/680) reported that their
education has been affected because of the ongoing conflict in Kashmir
except for five students. More than eight in ten students (82.4%, 560/680)
had lost a year of education due to the conflict in Kashmir and the remain-
ing 17.6% (120/680) did not lose a year.
The majority of the students were exposed to stressful and traumatic life
experiences while living in the conflict-affected Kashmir. They have been
exposed to the violence of conflict which has been challenging for their
mental health. A large number of students reported having developed
6 A. AHMAD DAR AND S. DEB

Table 2. Exposure to Kashmir conflict and its impact on health (mental and physical) and edu-
cation of young adults (n ¼ 680).
Sl. No. Statement Mode of response n (%)
01 Do you feel that there is violence in Kashmir? Yes 678 (99.7)
No 2 (0.3)
02 Do you feel psychologically distressed because of the Yes 649 (95.4)
present situation? No 31 (4.6)
03 Do you feel that you are suffering from some kind of physical Yes 410 (60.3)
sickness due to violence of conflict? No 270 (39.7)
04 Do you feel that people around you are developing psychological Yes 620 (91.2)
symptoms/diseases due to the ongoing conflict? No 60 (8.8)
05 Do you think that your education has been affected because of Yes 675 (99.3)
the present situation in Kashmir? No 5 (0.7)
06 Was there year loss in education because of violence in Kashmir? Yes 560 (82.4)
No 120 (17.6)

psychological and physical diseases due to the exposure of stressful life

events such as encounters, killings, pellets and teargas shells and other vio-
lence-related experiences. The verbatim responses of students in this
respect are presented here:
The frequent killings, hartals (Shutdowns), curfew, pellets, and encounters have created
fear everywhere—(male university student)
There is the complexity of many problems in Kashmir and conflict is the mother of
all—(male college student)
People are being killed and maimed in Kashmir—(male college student)
The violence of conflict challenges the mental health of people here—(female
college student)
We cannot escape our surroundings and they definitely have an impact on us—
(female university student)
The daily news regarding common people losing their lives distress us—(female
university student)
When I see my future and the future of Kashmir, there is only misery which is
unbearable—(male university student)
Sometimes I feel helpless when caught in unrest—(male university student)
Due to teargas smoke, I have developed throat problem and heart problems—(male
college student)
I am having difficulty in vision and chest pain after pellets hit my eyes and chest—
(male university student)

An overwhelming number of students reported that many diseases have

developed among the people of Kashmir such as depression, phobia, PTSD,
insecurity, worry, hypertension, heart problems, etc because of the ongoing
conflict violence in Kashmir. For example,
People have got a phobia of some normal things (e.g. sounds of opening or closing
of doors and windows, crowds, the voice of children in the playground, etc) that
something untoward has happened—(female university student)
 JOURNAL OF LOSS AND TRAUMA 7

People suffer from many diseases like depression, PTSD, suffocation, heart problems,
chest problems due to intense violence—(male university student)
Every family in Kashmir is affected by the conflict in one or the other way and
mental disorders such as PTSD are increasing day by day—(male university student)
If a child leaves for school or college in the morning, there is no guarantee that he
will come back alive, such is the gravity of the situation which leads to psychological
distress among people—(male college student)
My parents are worried about us which has caused hypertension to them—(female
university student)
People losing their family members suffer a lot of mental pain—(female
college student)

Almost all the students expressed that education has been seriously
affected by conflict situations in Kashmir and there was a year loss as dis-
closed by eighty percent of the students. There has been frequent suspen-
sion of schools and colleges, delay in exams as well as incomplete syllabus
resulting from the violence of conflict. Following are some of the verbatim
responses regarding the negative impact of conflict on education:
Proper education remains far apart and suspended because of the dangerous
situation in Kashmir—(male college student)
Our two-year course takes three years to complete—(female university student)
I believe we the students are victims of this conflict and in Kashmir, there is
frequent violence which leads us to devastation—(male university student)
Education has been adversely affected by the violence in Kashmir because schools
and colleges remain closed most often—(male university student)
There is suspension of classes mostly due to ongoing conflict in Kashmir which lead
to the loss of two years of our academics—(female college student)
I joined undergraduate course in 2015, now it is 2019 and I have still two semesters
left. Few of my class mates who left Kashmir for studies outside in different
universities of India, are now on the verge of completing their PG (post-graduation)
degrees. It is distressing while thinking about our career and education when there are
regular protests, strikes and curfews lasting for months—(male college student)

Discussion
The main objective of the present study was to estimate the impact of
armed conflict on the mental health of young adults in Kashmir. In this
context we found that Kashmiri youth has been exposed to the multitude
of stressful events such as encounters between militants and security forces,
violent protests resulted in exposure to teargas shells, pellets and killings,
prolonged shutdowns, etc. These events have challenged their mental as
well as physical health. Moreover, education has been found adversely hit
by the conflict in Kashmir.
8 A. AHMAD DAR AND S. DEB

The findings of our study showed that the mental health of Kashmiri
people especially the younger generation has been adversely affected by the
ongoing conflict. Participants reported being mentally affected and indi-
cated that people, in general, are the victims of mental disorders in the val-
ley of Kashmir. Earlier research has found a higher prevalence of mental
disorders among the Kashmiri people such as PTSD, depression, anxiety,
insecurity and so on (Bhat & Rangaiah, 2015b; de Jong, van de Kam, et al.,
2008; Housen et al., 2017).
Further, the findings disclosed that Kashmiri youth has been highly
exposed to traumatic events like pellet injuries and teargas shells which
have affected their physical health. Defected vision, throat infection, heart
problems, and chest pain are the common complaints reported. This is in
congruence with the earlier studies that exposure to pellets, teargas, and
other explosives cause serious physical problems (Bhat, 2019; Bhat et al.,
2017; Bhat & Rangaiah, 2015b; Deol & Ganai, 2018).
Furthermore, we found that education was the worst hit in Kashmir
because of the violence caused by the ongoing conflict. Educational institu-
tions remain closed most often which has resulted in the loss of educa-
tional year/years of the students and poor academic output. Previous
research has confirmed the negative effects of conflict situations on educa-
tion in the conflict-hit Kashmir (Ganie & Din, 2015; Hassan, 2012).
Therefore, it is evident from the above discussion that the ongoing
armed conflict in Kashmir has adversely affected the mental and physical
health of Kashmiri people in addition to career growth.

Implications
The findings of this study highlight the need to ensure mental health serv-
ices in Kashmir, specifically in the educational settings to identify and man-
age mental health disorders in youth. Further, the study offers insights
about the adverse conditions of life of traumatized people living in
Kashmir which might be helpful for the local administration and other vol-
untary organizations to understand effective ways to devise and implement
best intervention programs for maximizing protective factors of mental
health and minimizing its risk factors.

Limitations
The generalization of the findings of the present study may be restricted to
an extent because of certain potential limitations. First, the study covered
only undergraduate and postgraduate students in the age range of
18–25 years. Second, out of college and university students could not be
 JOURNAL OF LOSS AND TRAUMA 9

covered. Third, students from all religious communities could not be cov-
ered since they were not available. Fourth, data collected from the students
were based on self-report only. Finally, the study did not include case stud-
ies and/or in-depth data collection methods for cross-checking of informa-
tion provided through a semi-structured questionnaire method only.

Conclusion
It is thus concluded that the ongoing armed conflict in Kashmir adversely
affected the mental as well as physical health of young adult students. At
the same time, a large number of students expressed that their education
was badly affected by the continuous conflicts in Kashmir. Given the
potentially negative impact of conflict on mental health, efforts are sug-
gested in this direction to enhance the mental health support services for
the understudied population. Further, the formulation of programs at insti-
tutional and community levels are imperative for identifying and managing
mental health issues in the trauma-exposed population of Kashmir.

Acknowledgments
We extend our gratitude to the college and university authorities of Kashmir for permitting
us to collect data from students. We are also thankful to the students for their voluntary
participation in the study.

Disclosure statement
There is no conflict of interest involved in this work.

Note
1. https://www.msfindia.in/sites/default/files/2016-10/kashmir_mental_health_survey_
report_2015_for_web.pdf

Notes on contributors
Aehsan Ahmad Dar is a PhD research scholar at the Department of Applied Psychology,
Pondicherry University, India. His research focuses on trauma and recovery, clinical and
social psychology, and student mental health.
Sibnath Deb, PhD, DSc, is a professor at the Department of Applied Psychology,
Pondicherry University, India. He is the author of numerous publications, journal articles
and books. His research focuses on clinical and social psychology, child safety, student
mental health, Adolescent health, research methodology, monitoring and evaluation.

ORCID
Aehsan Ahmad Dar http://orcid.org/0000-0002-6467-5520
10 A. AHMAD DAR AND S. DEB

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