Spring In Afghanistan

Trauma Center

How do you bring peace to a country where everyone has PTSD and the only therapy is prayer?

ASFAKHAN, Afghanistan — Two weeks ago, police delivered several bodies loosely wrapped in cloth at the gate of Mazar Civil Hospital. Taliban fighters killed in battle, the officers explained to Abdul Hamid, the hospital gardener who was pulling a night shift as a guard. Take them to the hospital morgue, they said.

Then one of the shrouds slipped off. A man's ghastly head, decomposing and bloated after many hours in May heat, stared at Abdul Hamid from the stretcher. The ragged gash of an exit wound gaped blackly where the left temple once had been. Abdul Hamid passed out.

The next day, Abdul Hamid woke up without any feeling in the hands that had touched the grotesque cadaver. The morning after that, he woke up blind.

A five-day course of anti-inflammatory injections prescribed by an ophthalmologist had no effect. A textbook case of conversion disorder -- a common dimension of mental trauma -- a psychiatrist would have said, had Abdul Hamid seen a psychiatrist. But neither the gardener nor his family had ever heard of one. The culture of seeking cognitive therapy, like cognitive therapy itself, is almost nonexistent in Afghanistan. Its inchoate health-care system offers only 200 beds for mental-health patients in the entire country.

And so, eight days after Abdul Hamid's eyes refused to take in any more woe, a rickety zaranj moto-rickshaw carrying the 35-year-old man and his two weeping sisters joined the tumbledown procession of vans, trucks, taxis, and private jalopies that crawls steadily out of the sandbagged northern boundary of Mazar-e-Sharif, rattles past the lowland where the city dumps her refuse and human waste into black-rimmed lakes of stunning turquoise putrefaction, and jigs westward along a dirt track dead-ending at the Asfakhan Shrine.

The shrine's mud-brick beehive bell-jars the 830-year-old remains of a Muslim holy man named Mir Sangin. His tomb, a low adobe ziggurat painted pea green, is said to cure mental ailments. The men and women who pilgrim here in disturbed and desperate throngs are the truly forsaken in a land too busy fighting to care even for its healthiest people. The flotsam and jetsam of war hoping for a miracle.

By the most conservative estimates, two out of three people in Afghanistan suffer from post-traumatic stress disorder -- although the term's prefix seems inadequate in the land where trauma never ceases. Millennia of compounded war trauma have envenomed the country's population with mistrust, fear, and hypervigilance. When transcribed for the scale of a nation, experts who study conflicts believe, such symptoms, if unaddressed, impede reconciliation and help perpetuate war.

The signature injury of veterans of America's wars in Afghanistan and Iraq, "post-traumatic stress disorder" is a household expression in the United States. But in Afghanistan, where the noxious bouquet of depression, psychosomatic ailments, insomnia, rage, and panic attacks bleeds an entire society that for generations has been eking out an existence amid unending violence, it remains almost entirely unrecognized and untreated, says Dr. Mohammad Alemi, one of the country's leading psychiatrists who operates a 20-bed private psychiatric hospital in Mazar-e-Sharif. Most of the people suffering from the disorder come for comfort to shrines like the one in Asfakhan.

Each week, estimates Ishani Abdul Ahi, the shrine keeper, between 500 and 600 pilgrims journey to this eerie oasis in the sedimentary desert that yawns indifferently at the diaphanous Khorasan sky. Inside the sepulcher they claw at the walls and moan. They prostrate in prayer for hours on the carpet soaked with the urine of the incontinent. They weep silently beneath the swallow nests in the vaulted ceiling. They leave offerings of rice grains and money on the black cloth embossed with Quranic verses that drapes the tomb, and fasten their wishes to the tomb's pale railing with strips of cloth, tiny padlocks, and bits of thread.

"Miracles happen here," promises Ishani Abdul Ahi, whose ancestors have maintained the shrine for seven generations. "Crazy people come away cured." Several of his 20 grandsons, one of whom will inherit the esteemed position of shrine keeper from his grandfather, squat outside in the shaded arcade, selling trinkets, toy guns, and soft drinks cooled in buckets of murky stream water.

Last Wednesday, Abdul Hamid's sisters led the gardener into the shrine's putrid crepuscule and anchored him, teetering, on the floor near the northwest corner of the tomb. Next to him, a young man clasped the railing and shook. A few paces away, another man, recently paralyzed on his left side after a stroke, moaned a lament he alone could comprehend.

A woman ran fierce laps around the tomb, as she has done for 20 years, marking each footfall with a sharp, piercing shriek, as though her voice could scare away the destitution, horror, and war all around her. Then she collapsed on the floor in defeat.

Disoriented and frightened, Abdul Hamid wept.

The ammoniac reek of urine wafting from the floor of a place supposed to be holy, the cacophony of sounds -- the rattle of the metal railing, the woman's screams, the incoherent keening, the slapping of palms against adobe walls -- made no sense to him. His sudden blindness made no sense. "I am afraid," he whimpered, again and again, "I am so afraid."

He curled up against the corner of the tomb railing and tied, with his sisters' help, a plain white string to a metal post with long fingers he could not feel. His sightless eyes teared. He lay on the floor awhile. Unseen by him, swallows tumbled down elegantly out of their nests in the ceiling and dove through the shrine's open green door to somersault above the golden plains.

Majid Saeedi/Getty Images

Spring In Afghanistan

The Fight Goes On

In Afghanistan, bin Laden's dead and the Taliban don't care.

DASHT-E-LEILI, Afghanistan — Three green police pickup trucks roared up a serpentine gravel road and disappeared in cumuli of dust, careening toward Kushteppeh, where a government outpost was under attack by Taliban fighters. Moments later, seven motorcycle riders in black turbans -- masked, and armed with Kalashnikov assault rifles and at least one rocket-propelled grenade launcher -- inched out from behind a dune, pulled out onto Highway A76, and trundled in the opposite direction.

A decade ago, Jowzjan province became a grotesque symbol of Taliban defeat. In November 2001, U.S.-backed forces of Afghan General Abdul Rashid Dostum slaughtered up to 2,000 Taliban and al Qaeda prisoners of war here and dumped their bodies into unmarked pits, turning Dasht-e-Leili -- the "Lily Desert" in Dari, where skeleton plants' pale flowers push through the dunes toward an immense, bruised sky -- into the site of the first landmark atrocity in America's war against terrorism. The massacre's 3,014 survivors were taken to jail in the provincial capital, Shibirghan, and some were later transferred to Guantánamo Bay.

Ten years after the massacre, the Taliban are ruling entire districts in Jowzjan. They ride motorcycles fully armed through the province in daytime, set up impromptu checkpoints to levy taxes on travelers, and terrorize the province's meager police force. Likewise, the killing of Osama bin Laden, seen in Washington as a significant landmark that may somehow affect fighting in Afghanistan, has no more significance than any other war death in this loess vastness: just another element in the composite of violence that makes up the battered landscape of this graveyard of empires.

"Bin Laden was just one man. Why should his death bring any changes here?" said Colonel Nur Ahmad, the deputy police chief of Jowzjan province. "There are parts of the province where even the police can't go without risking death. Tell me: What does Osama have to do with it?"

That anyone should consider bin Laden's death auspicious to the course of the counterinsurgency is a surprising notion to many in northern Afghanistan, where the Taliban have been gaining rapid momentum over the past 18 months. In Balkh province, village elders, farmers, and taxi drivers have told me they saw no connection at all between the killing of al Qaeda's founder and war -- Afghanistan's near-permanent state for millennia, uninterrupted since the Soviet invasion in 1979. In Mazar-e-Sharif, where an enraged mob lynched 12 U.N. workers last month, Balkh provincial police chief, General Ismatullah Alizai, cackled with derision when I brought up bin Laden's name.

"They will produce 1,000 more Osamas!" he fumed behind a broad desk decorated with a jade plaque bearing his name and a red soccer ball wrapped in a garland of papier-mâché roses. "It is foolish to think that if someone kills the headmaster of a school the school will cease existing. Al Qaeda is like a breach in the hull of a ship. Killing Osama is like bailing water, and saying that we've closed the breach."

In Shibirghan, Colonel Nur Ahmad had no time for florid metaphors. We met in a stuffy office at the police headquarters that doubles as his bedroom. He wore plastic beige flip-flops with his uniform. His unmade cot was the berth of a man who sneaks naps between missions. He had been up until 4 a.m. the night before, monitoring by radio the latest Taliban assault on the police checkpoint in Kushteppeh, then got up shortly after dawn to wait for word about the number of casualties from the battle. When I mentioned the suggestion that bin Laden's death might pave the way for an early withdrawal of the approximately 100,000 U.S. troops deployed to Afghanistan, he looked panicked. Even Barack Obama's plan to begin reducing the number of U.S. forces in July, he said, is categorically premature.

"Osama may be dead, but the Taliban are stepping up their offensive," the colonel told me. He fiddled with his radio, listening for updates from Kushteppeh. He apologized for being distracted -- "the security is very bad, very bad" -- and offered a word of advice: "Don't travel through Jowzjan early in the morning, before eight, or after one in the afternoon. The rest of the time" -- a magnanimous way to describe a five-hour window -- "it is safe."

Thirty miles east on A76, in Jowzjan's Faizabad district, insurgents have launched at least one daily attack on government forces since May 1 -- the day bin Laden was killed. On Monday, Taliban fighters ambushed three Afghan army trucks, wounding several soldiers, and fired a rocket-propelled grenade at a border police car, narrowly missing it. "It's been really bad," said the district police chief, Commander Haidar. "For example, the highway you took here is not safe."

Faizabad has 33 villages. Nine of the most populous -- Haidar listed their names, using his orange prayer beads as an abacus to keep count -- fell into Taliban hands in the last 10 months. Haidar's 25 police officers, virtually immured inside their chipped adobe checkpoints, are no match for the insurgents, who, he estimates, number between 110 and 120 in his district and appear to enjoy popular support. The day of our interview, two armed men in the dark turbans and mismatched camouflage commonly worn by Taliban fighters watched the highway from the back of a motorcycle parked on a curb a mile or so east of one police checkpoint.

"If we have one man, they have 10; if we have 100, they have 100," Haidar said. "If my policemen peek out of a checkpoint, they'll immediately get shot. The only thing they can do is try to protect ordinary people on the highway -- but only if the Taliban are within a checkpoint's firing range. They can shoot at them from inside the checkpoint."

Haidar, by coincidence, shares an indirect connection with bin Laden: In 1996, he was a refugee from the Taliban in Abbottabad, the Pakistani town where the international terrorist was killed. "I was shocked when I heard about it -- it's such a quiet, elite little town," Haidar said. "I sold groceries there for five months. Then I moved to Karachi to work as a tailor."

A haboob was blowing from the west, and we stood on a barren plain outside the Faizabad police headquarters and watched. An enormous, mocha-colored roller tall as heaven sped toward us, pushing ahead buttermilk fog of steaming dust that blurred horizons, and devouring whatever was scattered along the highway: tattered motley flags on martyrs' graves; silver-lined poplar groves; gutted tank hulls, the rusted exoskeletons of bygone wars. It was past one in the afternoon, and Commander Haidar sent me on my way.

"If you see anyone in Afghan army camouflage and turbans, don't stop; the Taliban are using those uniforms," he warned. "And when you get back to Mazar, call me to tell me you've made it safely."

BAY ISMOYO/AFP/Getty Images