In her new book, The Occupied Clinic: Militarism And Care In Kashmir, US-based anthropologist Saiba Varma explores the psychological and political entanglements between medicine and violence in the world’s most densely militarised area. Over 16% of the civilian population in Kashmir suffers from depression, anxiety, post-traumatic stress disorder (PTSD) or acute stress, she writes, basing the figure on her research into interactions between healthcare workers and patients in a range of settings. She studies how colonisation gets embodied and “overlapping state practices of care and violence create disorienting worlds for doctors and patients alike”.
In an email interview, Varma explains how years of fieldwork has changed her idea of Kashmir, the way she was able to gain people’s trust and deal with the attendant suspicions, as well as privileges, of being an outsider. Edited excerpts:
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How did writing this book, while working in Kashmir amid the siege and lockdowns, change your idea of Kashmir and anthropology itself?
All academic work has political stakes. Doing research in the most densely militarised place in the world was immensely challenging but personally and intellectually meaningful. I was in Kashmir during the uprisings of 2010, 2016 and 2019. Experiencing these disruptions broadened my understanding of occupation as not just a political or military project but as a form of psychological and social warfare. As a researcher, I am interested in these subtle—but profound—effects of violence.
You write “there is no such thing as an innocent Indian…there is no innocent way for any other scholar of Indian origin, including myself, to engage with Kashmir (or any of the other colonialisms underway in the subcontinent) without acknowledging our own embeddedness in histories of violence and harm”. How did such engagement help in understanding these entangled histories as you interviewed affected people, caregivers and doctors in Kashmir?
When I wrote that “there is no innocent Indian”, I did not mean that all Indians are equally culpable, but that particularly upper-caste Hindu and middle- and upper-class Indians need to think about their complicity in state violence.
For example, I myself had to unlearn what I had been taught about Kashmir. It was represented to me as a place of “terrorism” rather than a place with a 450-year-long struggle for self-determination. As a researcher, I was changed by listening to stories of people in Kashmir—after all, anthropology is, at its core, a profound act of listening.
How difficult was it to gain the trust of a besieged people?
People in Kashmir are rightfully sceptical of outsiders. Many journalists, NGOs and government task forces have come and gone, (having) extracted and distorted information. In some cases, people were very trusting; at other times, I had to earn people’s trust over months, or years. Many people I interviewed were experiencing severe psychological distress. I tried to be mindful of the setting of the interview, making sure they had privacy. I also built trust before interviewing people. I have returned to Kashmir many times over the last 14 years. For me, these relationships come before research. I ask myself how I can serve the project of Kashmiri liberation.
You write that “people in Kashmir have much to teach us about how to survive, enact care, maintain hope, and live well”. How have people negotiated these “lockdowns within lockdowns” over the years?
Militarisation and surveillance transform every single decision people make— whether they should send their child to school, go to the hospital, how to walk on the street to avoid a soldier’s gaze. All of this has profound, long-term impacts on health and well-being. We talk about “PTSD” and “trauma” but the health impacts of militarisation are much deeper and broader than this.
In one chapter, I describe how people use the word kamzori (kamzoori in Koshur), which means physical weakness, but also collective moral and political weakness, an effect of being constantly under siege for centuries. As people told me repeatedly, “No one is healthy in Kashmir.” Health here is not just freedom from physical pain but also spiritual, moral and political well-being, freedom from oppression. To me, this is a much more richly textured language than a diagnostic term like PTSD.
What are some of the coping mechanisms devised by people in a society ravaged by violence, amid a tense present and an uncertain future?
I wanted to document the effects of militarisation without reducing people to victims. Military occupation and counter-insurgency produce social fragmentation—divide and rule—and foment mistrust. But has the Indian state succeeded in its project of social fragmentation?
In many ways, I would say no. During crises, people in Kashmir act collectively. They reassert their humanity in the face of brutal dehumanisation. For example, during the 2014 floods or the 2016 protests (after Burhan Wani’s death), people organised themselves and saved lives without being directed.
There are thousands of examples of survival and thriving that we can see every day—the way kids take over the streets to play a game of cricket during curfews, how people visit mosques or shrines as solace….These everyday practices show us that militarisation has not colonised all aspects of life in Kashmir.
What were some of the ways you found women coping with mental illnesses?
Women have experienced direct and indirect forms of state violence, in the form of sexual violence and harassment, as well as carrying the memories of loss in their families and communities. For unmarried women—both patients and psychiatrists—there is still a certain stigma around psychiatry but that is changing as more women enter the profession.
In many cases, women were very expressive about their needs after trauma. I describe a local NGO that surveyed PTSD sufferers. One woman in southern Kashmir’s Tral area, who had lost her husband in an encounter, told the NGO (which was focused on counselling and psychotherapy) that she did not want more counselling but financial help to rebuild the part of her house where the encounter had occurred. This was beyond the NGO’s scope and the NGO workers could not help. But she was crystal clear—for her, rebuilding her house was intimately connected to her recovery. She asserted herself; she was not a helpless victim. Yet the NGO, which was funded by a European humanitarian agency, had a totally disconnected idea of what “victims” in Kashmir needed.
How has the militarisation of public health centres over the past three decades affected the quality of, and people’s access to, healthcare?
My book argues that the Indian state has actively weaponised medicine in Kashmir. The public health system and the health of people has been deliberately and systematically targeted. The Indian state consistently tries to paint itself as a “healing” force in Kashmir rather than a perpetrator of violence. Beyond this, Kashmir’s public health infrastructure has been attacked, tear-gassed, and resources withheld. For example, I describe how village clinics were turned into interrogation centres during cordon and search operations. Such traumatic events re-emerge as fear and mistrust when people are accessing care. The hospital has become an extension of the battlefield.
The main aim of medicine—to provide care to people in a safe and secure manner—is rendered impossible. When we think about the impact of military and counter-insurgency practices, we must also consider how people’s health and well-being have been deliberately and violently eroded.
Majid Maqbool is a journalist and writer based in Kashmir.