Mohammad Qasim, a 58-year-old butcher, is traumatised, depressed and anxious — like 50 percent of his fellow Afghans after 30 years of war, according to government figures.
Qasim saw his wife, daughter-in-law and two grandsons aged five and six die in a horrific suicide bombing in Kabul last month.
More than 70 other people were also killed in the attack on a crowd of worshippers at a shrine during the Shiite holy day of Ashura on December 6.
“We are destroyed, our hopes are shattered,” mourned Qasim, sitting alone on a ragged carpet in an empty house once filled with his grandsons’ joyful playing.
“I always shout when that incident comes to my mind. I am sleepless. When I do sleep sometimes I dream about that dreadful attack, I wake up, cry and yell,” he told AFP.
Even while awake he has flashbacks, haunted by vivid images of the attack, causing him to lose track of where he is and feel that he is back at the scene of the carnage.
The intensity of the shock experienced by people as their lives change in an instant was captured in a powerful image by AFP Kabul photographer Massoud Hossaini, who was at the shrine when the explosion happened.
His photograph showing a girl dressed in green screaming in horror, surrounded by dead and wounded relatives, featured on newspaper front-pages around the world and has become one of the emblematic images of the Afghan war.
Qasim is suffering from post traumatic stress disorder, an affliction he shares with half of his fellow Afghans, according to the director of the health ministry’s mental health department, Doctor Bashir Ahmad Sarwari.
“Two out of four Afghans suffer from trauma, depression and anxiety — they make up some 50 percent of the population,” he told AFP.
“They are in trauma mainly because of three decades of war, poverty, family disputes and migration issues.”
Sarwari says that although the number of mental health specialists is growing — there are now about 70 — they cannot cope with the demand for treatment in a population of some 30 million people.
Hospital facilities are also pitiful — there is just one state-run mental health hospital with 100 beds, backed by small care centres in some private hospitals.
But that is also an improvement. After the fall of the hardline Islamist Taliban government in the 2001 US-led invasion, there were no mental health services at all.
The experience remains bleak for victims, however, with a visit to a ward in the state-run hospital revealing two patients sitting on beds with their knees drawn up to chests, another on his side, eyes open, face grey.
The floor is concrete, the sheets are worn and the dimly lit ward is warmed in mid-winter only by a small electric heater.
The United Nations says the number of civilians killed in violence in Afghanistan rose by 15 percent in the first six months of last year to 1,462, with Taliban insurgents blamed for 80 percent of the killings.
Many men in Afghanistan suffer the same trauma as Qasim, but remain silent about it, believing that to admit mental problems is a sign of weakness, says Wolfgang Tissen, chief of the mental health project run by the humanitarian International Medical Corps.
“If you say there is a population of 30 million and 100 psychiatric beds, normally it would be overcrowded, but it isn’t, because of the stigma. People are ashamed to say when they have psychiatric problems,” he said.
“I believe men are suffering from (depression and anxiety like the women) but they don’t want to come to hospital,” said Dr Abdul Qawi Alimi, a mental health expert.
“It’s because of our culture. Some people don’t want to show their problems. People will call the patients ‘crazy’ or ‘useless’. There is a lot of shame involved.”
But Alimi said he hoped that community awareness projects were helping more people accept the need for treatment.
Qasim, the traumatised butcher, ran his shop before his life changed in an instant on December 6. Now he is unable to work and his two sons are taking care of the family.
“I want another suicide attack to take my life. After the death of my wife, daughter-in-law and my two grandsons this life is meaningless,” he said.
His only hope for a faint echo of his old family life now lies with his two young granddaughters, who were injured in the blast. They have been discharged from hospital, but their wounds — mental and physical — mean they cannot play as they used to do.