Health gaps in conflict-affected Kashmir

This is article no. 5 in a series about global health injustices. Previous article: Syria and Lebanon’s diverging yet connected struggles. Next article: Health inequalities in Bangladesh.

Introduction

Welcome to the fifth article of the Global Health Injustices Series. The previous article was a collaborative endeavour focused on the populations in Syria and Lebanon. Now, I will focus on the people living in Kashmir, who are currently experiencing a lot of health and wellbeing challenges, primarily attributed to conflict. For example, on top of the enduring conflict in Kashmir, the COVID-19 pandemic had worsened the mental health of the Kashmiri population, where 1.8 million adults were living with any type of mental distress. Despite these concerns, the Kashmiri people have not had their voices heard as clearly in mainstream discourse compared to other vulnerable populations discussed in previous articles. 

Kashmir: a rich history to current conflict

Kashmir (also known as Jammu & Kashmir) is a region within the Northern Indian subcontinent, bordered mainly by Pakistan and China. Kashmir is a disputed territory between the militaries of India and Pakistan since the Indian subcontinent was divided up by the British Empire in 1947. Even before that, conflicts were driven by issues with local governments and tensions between cultural and ethnic groups within the region. These issues, among others, have contributed to the instability and health challenges encountered by the Kashmiri people.

In recent years, tensions and violence have accelerated, particularly in 2024, due to the Indian government wanting to maintain control of the Kashmiri region. This has led to vast protests and friction between civilians and armed forces. In turn, this has weakened ties within the region, particularly between India and neighbouring nations. Another overlooked impact (which I will be discussing further) of this current conflict is on Kashmiri women, who encounter certain challenges, which include loss of family members, displacement and Gender-Based Violence. 

Considering this background of Kashmir is crucial because it will help with understanding the current geopolitical climate and how it detrimentally affects the health of the Kashmiri people. 

Geopolitics and health in Kashmir

Similar to the populations discussed in previous articles, the Kashmiri people are encountering a lot of mental distress attributed to the ongoing conflict. One study from 2009 found that the prevalence of depression was 55.72%. Meanwhile, another study from 2017 uncovered that approximately 45% of adults experienced mental distress, with specific rates of 41% for depression, 26% for anxiety, and 19% for post-traumatic stress disorder (PTSD). This difference presumably came from wider geopolitical factors, as measuring mental health is challenging during conflict.

As such, the healthcare system in Kashmir needs urgent improvement to better support mental health. Even though it does better in some areas compared to the national average, the demand for services, especially in conflict-affected areas, is overwhelming. There are not enough mental health professionals, and many healthcare providers lack the training to handle trauma-related issues properly. Investing in training, community mental health initiatives, and integrating mental health services with regular healthcare could help improve the overall mental health of the Kashmiri people. Focusing on mental health just as much as physical health to build resilience in Kashmir is essential.

As for the health infrastructure in Kashmir, noted in one review, they have 4433 government health institutions and a doctor-patient ratio of 1:1880, which is lower than the World Health Organisation (WHO) recommendation of 1:1000, yet higher than the national level of 1:2000. Moreover, the state of Kashmir was shown to have better health indices compared to the national average, including life expectancy, infant mortality rate, and crude birth and death rates. Despite these improvements, challenges persist, such as the inadequate health infrastructure and a shortage of financial resources and technical staff, despite relatively stable trends (Table 1). 

In one study, the authors noted that among the Schedule tribes in Kashmir, they encounter significant health challenges attributed to illiteracy, poverty, and inadequate healthcare facilities and infrastructure, leading to increased non-communicable diseases (NCDs). There is a high prevalence of poor nutrition and undernutrition, which contributes to the susceptibility of these populations to NCDs (7). Moreover, a lack of access to clean water and sanitation worsens health issues, which increases their risk of infectious diseases. Social taboos and beliefs hinder healthcare service utilisation among the population, which impacts health outcomes and even awareness of NCDs (Figure 1).

Focusing on violence exposure in Kashmir, another study among households found that respondents documented high levels of violence, which include: exposure to crossfire (85.7%), round-up raids (82.7%), witnessing torture (66.9%), experiences of rape (13.3%) and forced labor (33.7%). What this study also found was that males noted more violent confrontations and had higher odds of experiencing different forms of maltreatment compared to females. Given that this study was conducted in 2008, these figures are likely to be either higher or lower now, depending on the magnitude of violence and warfare. Nonetheless, the high frequency of violence has led to substantial health issues, specifically mental health problems among the affected Kashmiri population.

A severely overlooked impact of conflict in Kashmir is on the women, who encounter specific tragedies, including loss of family members and displacement. Moreover, the use of rape as a weapon in conflict stresses the convergence of gender and political power, particularly in Kashmir. Unfortunately, there have been some researchers who usually depict Kashmiri women as solely victims, which can undermine their autonomy and political involvement. Therefore, addressing the plight of Kashmiri women by allowing them to discuss their experiences openly and actively involving them in key decisions regarding Kashmir can be a vital stepping stone towards supporting their health and well-being.

To truly understand all of the various health challenges illustrated above impacting the Kashmiri population, it is vital to cite the various geopolitical factors I discussed in previous articles on Yemen, Sudan and Palestine. The most notable factor is the continuous international weapons/ arms trade, which I firmly believe must be thwarted because of how much damage it has caused, particularly through the sale of bombs and other explosives used to target the most vulnerable populations. However, stopping this trade requires actual political will and legislation, which is unlikely to happen anytime soon because our leaders make a lot of profit from selling weapons.    

NGOs: their role in supporting Kashmir

International non-governmental organisations (INGOs), notably Aakar Patel, chair of board at Amnesty International India, shared this statement in 2024 regarding Kashmir:

Amnesty International also shared testimonies from a few Kashmiri people:

- Masrat Zahra, an award-winning Kashmiri photojournalist.

- Iltija Mufti, daughter and media advisor to ex-chief minister of Jammu & Kashmir.

To address the complex health and social issues previously discussed, international organisations and local communities need to come together for solutions. Programs focusing on building mental health support, improving healthcare availability, and creating safe spaces for women and young people can make a difference. The Kashmiri people need to have their voices heard in discussions about their health and wellbeing. Otherwise, their challenges will continue to affect their lives.

Conclusion

Overall, the health and well-being issues in Kashmir are closely linked to the long-standing conflict and warfare. Although this region has a rich cultural history and shows a lot of resilience, the current conflict has caused unfathomable mental distress and health problems for the Kashmiri people. The rise in mental health issues and the inadequate healthcare infrastructure illustrate that reforms are urgently needed. There is a real shortage of support for mental health, particularly when dealing with the trauma from ongoing violence.

Moreover, marginalised groups face tremendous health challenges because of various factors ranging from poverty to a lack of education to limited access to basic needs. Living in violence and conflict not only affects physical health, but also leads to ongoing psychological trauma that is often ignored. Tackling these health inequalities and inequities requires a comprehensive approach incorporating mental health care into the standard healthcare system, improving access to clean water and food, and building communities.

Listening to the Kashmiri people and focusing on their health needs is key to achieving peace and better living standards in the region. Therefore, national and international players must recognise these issues and take real action to ensure they receive the support they need and deserve. Only with continued efforts can we expect a healthier future for Kashmir. The following article in the Global Health Injustices series will focus on Bangladesh and the plight of the Rohingya population, which will also be a collaborative endeavour. 

Written by Sam Jarada

Related articles: Impacts of global warming on dengue fever / Understanding health through different stances / South Asian famine / South Asian mental health

REFERENCES

Sheikh Shoib, Arafat SMY. Mental health in Kashmir: conflict to COVID-19. Public Health. 2020 Sep 1;187:65–6. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC7484691/

Center for Preventive Action. Conflict Between India and Pakistan. Global Conflict Tracker. 2015. Available from: https://www.cfr.org/global-conflict-tracker/conflict/conflict-between-india-and-pakistan

Zeeshan S, Hanife Aliefendioğlu. Kashmiri women in conflict: a feminist perspective. Humanities and Social Sciences Communications. 2024 Feb 12;11(1). Available from: https://www.nature.com/articles/s41599-024-02742-x 

Amin S, Khan A. Life in conflict: Characteristics of Depression in Kashmir. International Journal of Health Sciences. 2009 Jul;3(2):213. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC3068807/ 

Housen T, Lenglet A, Ariti C, Shah S, Shah H, Ara S, et al. Prevalence of anxiety, depression and post-traumatic stress disorder in the Kashmir Valley. BMJ Global Health. 2017 Oct;2(4):e000419. Available from: https://gh.bmj.com/content/2/4/e000419

Mir A, Bhat S. Health Status and Access to Health Care Services in Jammu and Kashmir State. Asian Review of Social Sciences [Internet]. 2018;7(3):52–7. Available from: https://www.trp.org.in/wp-content/uploads/2018/11/ARSS-Vol.7-No.3-October-December-2018-pp.52-57.pdf

Habib A, Iqbal A, Rafiq H, Shah A, Amin S, Suheena, et al. Trends in the Magnitude of NCDs among Schedule Tribe Population of Kashmir with Special Reference to Health and Nutritional [Internet]. Journal of Community Medicine & Public Health. Gavin Publishers; 2023 [cited 2025 May 5]. Available from: https://www.gavinpublishers.com/article/view/trends-in-the-magnitude-of-ncds-among-schedule-tribe-population-of-kashmir-with-special-reference-to-health-and-nutritional 

Jong K de, Ford N, van, Kamalini Lokuge, Fromm S, Galen R van, et al. Conflict in the Indian Kashmir Valley I: exposure to violence. Conflict and Health [Internet]. 2008 Oct 14 [cited 2025 May 5];2(1). Available from:

https://conflictandhealth.biomedcentral.com/articles/10.1186/1752-1505-2-10 

Authorities must end repression of dissent in Jammu and Kashmir [Internet]. Amnesty International. 2024 [cited 2025 Jun 11]. Available from: https://www.amnesty.org/en/latest/news/2024/09/india-authorities-must-end-repression-of-dissent-in-jammu-and-kashmir/