By Zabihullah Noori
LONDON (Thomson Reuters Foundation) - When psychiatrist Ghulam Sarwar Sakha first met a 23-year-old woman who had been studying in the northern Afghan city of Kunduz when it was stormed by the Taliban last year, the trainee teacher could not drown out the voices in her head.
Locked in her room to avoid the fighting that raged on the streets outside, the student started hallucinating.
"'I receive warnings and threats. They say I am bad girl. I don't wear a hijab. They are going to come and get me'," said Sakha, recalling the words of his patient.
It became so bad that her parents took her to a doctor who prescribed medicine for a physical ailment. But in reality, she was suffering from schizophrenia, said Sakha, who treated the woman during a visit to his homeland to do charity work.
Some 10 million Afghans - nearly a third of the population - who are facing mental health problems, according to the country's health minister.
Decades of conflict, suicide bombings, displacement, poverty and unemployment have taken a huge toll on Afghans, and left a health system that is under-funded and ill-equipped to provide care to citizens, health experts say.
Insecurity and a lack of funds have prevented a nationwide study of mental health issues but a 2013 report by the World Health Organization (WHO) said surveys had indicated consistently high levels of mental distress in the population.
Substance abuse has been on the rise since 2000, it said.
"No one knows what is going on and what is going to happen to them, and it makes them anxious and depressed," said Eklil Hayat, a doctor in the capital Kabul.
"Perhaps the most obvious signs of mental health problems are that the people have become less tolerant and more impatient," Eklil told the Thomson Reuters Foundation by phone.
MEMORY LOSS, NIGHTMARES
Most mental health patients do not know or do not wish to admit that they have problems due to stigma surrounding the issue, said psychiatrist Sakha, who also chairs the Bahar-e-Mayhan Foundation in London, which supports projects to boost education, and help women and children in Afghanistan.
"I had more than one hundred sessions with patients who thought they were physically ill, but in fact they were all mentally ill," Sakha told the Thomson Reuters Foundation.
"Almost all of them complained about constant headaches, memory loss, lack of concentration, lack of sleep, nightmares - which are signs of mental illness."
In the years after a U.S.-led invasion toppled the Taliban government in 2001, there was a drive by international non-governmental organisations to develop mental health services in Afghanistan.
For example, in the western province of Herat, International Assistance Mission set up community mental health services and provided training for doctors, nurses and midwives, WHO said.
As a result the proportion of patients diagnosed and treated for mental health problems rose to 5.2 percent in 2011 from 1.5 percent in 2005, it said.
But the gap in meeting needs remains vast.
Figures released in 2015 by the health ministry showed there were only 200 psychological counsellors for the whole country.
Bashir Ahmad Sarwari, head of the mental health department at the Afghan Ministry of Public Health, said there had been improvements in recent years with basic mental health training provided to almost 600 health professionals.
Sarwari told the Thomson Reuters Foundation that 300 counsellors are now working in health centres in Afghanistan.
Yet basic counselling has a limited impact, according to Khesraw Parwiz, who worked in the mental health department of the health ministry from 2010 to 2015.
"But with five professional sessions, people with mild mental health problems can be taught the basic coping method," he said.
In the absence of professional healthcare many desperate families turn to traditional healers for help with reports of some patients being chained.
"If a person without mental health problems is chained somewhere with no access to sunlight and proper food, he will get physically and psychologically sick, let alone a mentally ill patient," Sakha said.
(Editing by Katie Nguyen. Please credit the Thomson Reuters Foundation, the charitable arm of Thomson Reuters, that covers humanitarian news, women's rights, trafficking, property rights and climate change. Visit http://news.trust.org to see more stories)