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16 January 2012

Medica Afghanistan: Psychosocial counselling and training

Everyday life for women in Afghanistan is still characterised by extreme breaches of human rights. According to UN reports, rape is still commonplace and 87 per cent of women are regularly beaten. This often leads to serious psychosocial problems and even psychosomatic illness. Medica Afghanistan offers Afghan women regular conversation groups and individual counselling sessions to help them deal with their trauma and find a new lease of life.

Counselling for Afghan women and girls

The psychosocial counselling program at Medica Afghanistan set up consultation rooms in five neighbourhoods of the Afghan capital Kabul. This makes it easier for as many women as possible to find a protected space near their home where they can come to meet others and benefit from psychosocial support.

Afghan psychologists from Medica Afghanistan also hold one-to-one and group counselling sessions in the “Women’s Garden”, a centre run by the Afghan Ministry for Women’s Affairs which is only accessible to women. Some of the women just come once to receive advice and others are given support in the form of regular one-to-one sessions over the course of several weeks or months. Group sessions also offer women the chance to learn physical exercises that help reduce stress and to meet other women similarly affected. This form of mutual support is a completely new experience for almost all who take part.

Prisoners from the women’s jails in Kabul and Herat and from the juvenile detention centres also benefit from weekly one-to-one and group sessions with the psychologists. And they also provide psychosocial counselling to women in the four women’s safe houses in Kabul.

It helps to talk. For many women, the counselling sessions are the first opportunity they have ever had to talk about the burdens and/or trauma they experienced because shame and taboos or fear of reprisal from the perpetrators generally prevent women in Afghanistan from talking about the violence they suffer. A total of some 2,300 women have received psychosocial advice in group and one-to-one sessions since the project started in 2004.

Additionally, in 2009 Medica Afghanistan managed to persuade three hospitals in Kabul and Herat to install consultation rooms, providing an undisturbed space where psychosocial counsellors and doctors can talk confidentially to patients who have suffered violence. The consultation rooms in the hospitals also provide a secure place for women to seek counselling even if their families don’t approve since they can go there under the guise of attending a medical examination. In the hospital in Herat, the psychologists also talk to the patients in the burns ward. Self-immolation is unfortunately a common way to commit suicide in Afghanistan and many Afghan women are driven to this as a last resort to escape overwhelming psychological and physical violence.

Learning to read and write

The psychosocial groups on offer at Medica Afghanistan in Kabul also include literacy courses which women can attend together with their children. After the conversation groups, the women can learn to read and write and they are also taught about health issues and informed about their rights to education and medical support. One aim of the courses is to give women the skills they need for simple jobs, such as shop or market sales assistants. And they also provide them the opportunity to continue to meet as a group and support each other when it comes to family issues. Some 400 women have already completed the literacy courses.

Training in psychosocial counselling and trauma work for female Afghan professionals

In 2003, medica mondiale had already begun to offer further training to female Afghan specialists working in psychosocial and medical fields. Since then, some 440 social workers, psychologists and members of other professional groups working with women have attended 2- to 4-week training courses to learn psychosocial counselling and trauma-sensitive treatment skills. During the training courses, the participants learn the basics of psychosocial counselling and discuss experiences from their working lives. Importantly, they also have the chance to talk about their own personal experiences of violence.

The first success is visible: Participants in the courses are increasingly applying the methods learnt during their work and public acceptance of psychosocial counselling is growing in Afghanistan. Demand for these training courses is also increasing. The inquiries come from Afghan and international NGOs as well as Afghan government authorities and health institutions.

A real example: Help for women in marital disputes
A husband goes to the doctor and asks for his wife to be examined vaginally in order to check if she was unfaithful. He claims that his wife did not come home by 4pm as they agreed, so he suspects her of having an affair. The (female) doctor refuses to examine his wife. Instead, she talks to him about his concerns and explains that he should trust his wife more when she goes out of the house. She asks him what he thinks would happen with a “vaginal examination”. Does he want to send vaginal secretions from his wife to a laboratory? Doesn’t he consider that to be a bit strange? The man no longer insists on subjecting his wife to an examination. He obviously feels somewhat ashamed and he and his wife go home together.

Public education by radio

To raise awareness of violence against women and its consequences, Medica Afghanistan produces radio programmes with interviews and reports on the topic of “Psychological health”. Listeners in Afghanistan gain an impression of the psychosomatic illnesses caused by the trauma women experience by hearing anonymised interviews with patients and hospital staff. This is a good way to reach the large proportion (over 80 per cent) of Afghan women who cannot read or write.

Ten programmes on the topics of trauma, sadness and depression have been produced so far. Broadcast throughout the country on various Afghan radio stations, they always attracted widespread attention.