Insomnia and nightmares, heart palpitations and aggression – a year after Asif Maharramov was sent to fight in a brutal conflict between two former Soviet rivals, he suffers from lingering psychological injuries.
For six weeks last fall, his country, Azerbaijan, fought neighboring Armenia for control of the disputed Nagorno-Karabakh region in a war that left 6,500 dead and exposed the enemies of the Caucasus to de deep societal traumas.
Maharramov, 20, is among thousands of veterans from both sides with post-traumatic stress disorder (PTSD) in patriarchal societies where seeking mental health help may be taboo.
Armenia and Azerbaijan are working to expand access to psychological care for ex-servicemen, an effort that is gradually attracting hardened ex-combatants who overcome fear of being seen as weak.
But the challenge of reaching all who need help is enormous.
“A year has passed since the war but the stress is still there,” Maharramov told AFP, listing symptoms including rapid heartbeat and insomnia.
“My mood got worse. When I hear someone say something I don’t like, I want to hit them. It’s out of my control.”
Health professionals in both countries have lamented an underdeveloped culture of psychiatric treatment which they say hinders efforts to help veterans diagnosed with PTSD.
– Dreams of the dead –
“Only a quarter of ex-combatants agree to undergo treatment,” said Dr Khachatur Gasparyan from the Intra psychological center in the Armenian capital Yerevan.
“Society has to be taught that there is nothing to be ashamed of in seeing a psychologist – that it is normal,” he said.
In January, Azerbaijan set up psychological rehabilitation centers for ex-combatants in all major cities.
“Since then, the number of ex-soldiers seeking psychological treatment has steadily increased,” said psychologist Sabina Rashidova.
The center of Baku, the capital of Azerbaijan, receives around 50 ex-soldiers every week, with treatment cycles focusing on psychotherapy and drugs.
His colleague Nargiz Huseynova said they regularly experience “aggression, insomnia and apathy”.
Maharramov was among those who received treatment.
Sent to war after the clashes that broke out on September 27, he spent his first night under artillery fire.
His team managed to seize a strategic position on top of a hill, but Maharramov was injured in the head and his captain was killed.
“We saw him lying on the ground and blood was flowing,” Maharramov said.
He spent five months in a hospital to be treated for a head injury and PTSD.
“I often see him in my dreams,” Maharramov said of his captain. “I often see my fellow soldiers in my dreams. They scream, call me.
The Armenian government has launched a similar network of rehabilitation centers for ex-combatants, ex-prisoners of war, and families of the dead and missing.
Program coordinator Andranik Hakobyan told AFP he hopes 10,000 people will benefit from rehabilitation services, citing “shock, rejection and guilt” as endemic problems.
Weather was a factor, he added: “Without timely psychological help, they suffer from suicidal thoughts or become aggressive.
– “No winners” in the war –
“There are no winners or losers in the war,” he added. “Armenians and Azerbaijanis are also suffering from the consequences of the war. We all have a long way to go towards psychological recovery. “
David Stepanyan, who narrowly escaped death on his first day of fighting when an Azerbaijani shell blew up a car he had just exited, is still on the road.
The 21-year-old was wounded less than a month after the start of the war and taken – unconscious – to a hospital, where medics told him a sniper bullet had pierced his flesh a few millimeters from his heart.
The bullet is still lodged in his chest and his whole body is scarred, but it is the psychological wound he struggles with the most.
For months, he said, he couldn’t sleep well and fragments of war memories encroached on his dreams and waking hours.
“I could not interact with my family or my friends and I finally decided to seek treatment,” he told AFP.
“The worst memories of the war are the times when you see your wounded friend nearby, but can’t help him because of heavy enemy fire,” he said.
But he said eight sessions of psychotherapy had brought some relief and he could now sleep up to four hours a night.
Not everyone is progressing.
Maharramov, the Azerbaijani veteran, now works as a security guard at an oil installation outside Baku and believes his life is lacking in prospects.
“If I ever get married, there will be no music at my wedding party,” he told AFP.
“I know people who will never get married because they died in the war.”
© 2021 AFP