Institute for War and Peace Reporting IWPR, UK
March 12 2010

KARABAKH WAR STILL FINDS VICTIMS

Fifteen years on, doctors say disease brought on by stress of war
continues to kill people.

By Karine Ohanyan in Stepanakert

Nagorny Karabakh has been at peace now for 15 years, but doctors fear
the war is still killing people through higher rates of stress-related
disease.

And some health officials in the enclave, which has proclaimed its
independence but not been recognised by any member of the United
Nations, say they are dealing with a `Karabakh syndrome’ of cancer,
heart attacks and more.

Silva Grigoryan, 34, said she never suffered from anything worse than
the flu before the war, but shortages and the strain of the fighting
undermined her health.

`There was no electricity, no gas, no bread. It was a terrible siege.
But I did not notice it then, the only important thing was to survive
the bombardment. We timed the periods when the artillery stopped `
they were 40 minutes long ` and ran upstairs, to the flats, to use the
toilet, to eat, to wash,’ she remembered.

`We only worried about whether our loved ones would survive. We even
used to tell each other jokes, and read each other books by
candlelight. We had to find something to fill the time we spent in
those basements.’

Within three years of the war’s end, however, this robust teenager had
become an invalid. She developed stomach ulcer and thyroid problems
and needed an urgent operation.

`The doctor said this was all because of my nerves,’ she said. `It was
a result of the stress dating from the war.’

The Karabakh war started in 1988 with clashes between Azeris and
Armenians over the future of the region, which was part of Soviet
Azerbaijan but inhabited mainly by ethnic Armenians. The war ended
with a ceasefire in 1994, and the situation has been largely stable
since then although the conflict is still unresolved.

Armen Khachatryan, the republic’s health minister, put a positive spin
on the health crisis, saying the rise in heart disease, stroke,
diabetes and more was part of a global trend.

`But of course, for these diseases stress is the trigger mechanism.
Yes, ecological and genetic factors also have a great significance,
but stress is the reason for their appearance and war, of course,
leaves its mark in the increase in these diseases,’ he said.

According to statistics, Karabakh had about 4,447 cases of cancer in
1985, before the war. In 2005, this number had almost doubled to 8,964
cases. Faraon Adamyan, a leading cancer specialist in the region, said
the war had undoubtedly helped trigger the increase.

`Several of my colleagues here and in Armenia have published articles,
and spoken at conferences at the National Oncological Centre, and
there is evidence to say that in the years during and after the war
there was a sharp rise in cancer,’ he said.

He said the rise was most noticeable among Armenians who had fled to
Karabakh from Baku and other places in Azerbaijan that had sizeable
Armenian communities in Soviet times.

`Oncology is one region where stress can be the trigger for the
development of the disease, and in the war, every second person had
terrible stress. And why just every second? Every first person had it
too,’ he said.

The decline in general health in Karabakh can also be partly be
explained by the collapse of the health system during the war. Doctors
were forced to focus on emergency procedures, giving up on
prophylactic medicine, and were short of drugs and bandages.

Since then, the government has moved away from the universal free
healthcare of Soviet days and brought in payment for services, which
means many people are unable to access doctors.

`Medicine is now paid-for, and not everyone can afford regular
check-ups, daily medicines, the prophylactic measures against disease.
These are also factors which affect the increase in illness,’ Neda
Nersesyan, a cardiologist, said.
But she said that was not the whole story. Heart attacks, for example,
had become a serious problem.

`Before, a heart attack was a rare event. Who has ever seen as many
heart attacks as we have now?’ he asked.

Karabakh doctors say that the human brain dulls the pain of the worst
memories, but they wondered if the body has a form of `passive memory’
in the subconscious that could explain the persistence of
stress-related diseases so long after the conflict ended.

`Today we can already talk about a `Karabakh syndrome’, since the
Karabakh war made such a big mark on the residents of post-war
Karabakh,’ said Hakob Hakobyan, the head doctor in the Stepanakert
psycho-narcological dispensary. He said war affects the psychological
condition not only of those who fight in it, but of everyone who feels
worry or stress as a result of the fighting.

Gayane Arustamyan, a 42-year-old mother of two, has recently learned
she has cancer. The disease was discovered at a late stage and,
although she is undergoing chemotherapy, she thinks that only God can
save her now.

`I worked in a kindergarten before the war. Then I lived through
everything you could live through. I took my sons, who were two and
five, in my arms during the bombardment, and ran to hide in the
basement. I waited for my husband to come back from the front, and
prayed for him every day,’ she said.

`When he came home, he started to drink and became an alcoholic.’

Karine Ohanyan is a freelance reporter in Stepanakert.