By Nadia Batool Bokhari

Durham resident Kamil Arzish, 25, was born and raised in Quetta, Pakistan, and still struggles with the memory of a bomb blast that killed 115 Hazara Shias and wounded more than 270 the year before he moved to this country.

He was 16 and still grieves for his community that was targeted just 10 days into 2013.

The next year, when he was 17 years old, he came to the United States because of the horror.

The Hazara minority, a population that stretches across Pakistan and Afghanistan, are Shia Muslims and have different cultural practices, distinct from many of the Sunni communities in both countries. The facial features of the Hazaras reflect their ancestry of people from Mongolia and Central Asia, something that makes them readily distinguishable from other Afghans, who look more European.  

There wasn’t just one bomb blast in 2013. Slightly more than a month later, on Feb. 13, another deadly blast left 73 Shia Hazra dead, and at least 180 people wounded. On June 30 that same year another suicide attack targeted Hazaras, leaving 33 dead and at least 70 wounded. 

This chain of attacks continues in Pakistan and Afghanistan.  

“How can I forget [a] bomb blast, target-killing in broad daylight in the city and city center,” Arzish said. “All because we look a certain way and belong to the Shia sect. It was just an awful experience, it was hopeless and helpless in Pakistan.”

When Arzish moved to the United States seven years ago, he was granted asylum. 

Now he works at an insurance company in Durham. He said he feels secure in North Carolina, but cannot escape the pain of targeted killings of the Hazara Shia going on in Afghanistan. There has been a non-stop series of ethnic-cleansing attacks, getting worse and worse in Afghanistan, more so than in Pakistan.

Arzish said he hopes to direct the world’s attention to the plight of his Hazara community in Pakistan and Afghanistan, where he believes the killing needs to stop.

“I grew up … listening [to] our tribe story that we came as refugees in Balochistan [present Pakistan] from Afghanistan to avoid our community genocide, but since [the] last two decades in Pakistan my community is always in fear of persecution,” Arzish said during interviews conducted in English and Urdu. 

Arzish has found communities in New York, where he lived after arriving, and in North Carolina that are very supportive and welcoming to him. Nonetheless, Arzish still suffers from post-traumatic stress. 

His employer has helped him with the problem by providing him with insurance that has connected him with medical care and mental care. He also got mental counseling at his high school and college. He has high praise for the help that he received there. 

But Arzish also said that he’s not certain that people in this country, who haven’t experienced what he did in Pakistan, might not be able to fathom the stress and mental health problems that come with fleeing such trauma. 

Shows a group of grim looking men and boys holding up signs saying, "stop killing Hazaras" as they sit in front of candles.
A photo from a February 2013 protest held by the Hazara Shia community in Quetta, Pakistan in the wake of several horrific bombing that killed dozens. The residents were protesting the Pakistani government’s slow response to the attack and the government’s lack of response to attacks from armed Sunni groups. In the wake of the attack, ambulances and fire services were slow to arrive. The local Hazara community said that was because the Pakistani government was discriminating against helping them. Photo credit: Daniel Schmidt, ABC Open/ Flickr Creative Commons

In North Carolina, as refugees from Afghanistan begin to resettle here, Arzish questions whether there could be a better support system for the new arrivals who might have experienced similar trauma.

There are few non-profits providing counseling services specially tailored for refugees. They are arriving in a state where mental health services already are difficult to access, disjointed and underfunded. Longtime residents also know the challenges, all too well. 

PTSD common for refugees

“Many refugees who are resettled have typically endured three distinct chronological periods of traumatic exposure,” said Erum Agha, a postdoctoral research fellow at the UNC-Chapel Hill School of Medicine.

Agha explained that the research shows refugees’ trauma often has three stages:

  • Pre-migration stage, when people are still in their country of origin;
  • The flight stage, when people are escaping; and
  • Trauma that occurs during the resettlement process.

She said that refugees have lived through numerous traumatic events, placing them at a high risk for post-traumatic stress disorder, or PTSD, which can result from a single traumatic event or a series of events in a short duration. 

Some refugees, like Arzish, have faced long periods of exposure to trauma.

Additionally, Agha explained that multiple forms of trauma can make a person vulnerable to chronic trauma, something that results from repeated or prolonged exposure or multiple traumatic events.

All of that kind of cumulative exposure has been found to be associated with a wide range of health and behavioral health problems, such as anxiety and depression, among refugees.  

Even after resettlement, many refugees are met with challenges related to adjusting to life in a new country, as well as social and economic factors such as poverty, social isolation, language barriers and acculturation.

Agha pointed to research showing that stressors can create high levels of distress and can act as reminders or triggers of past traumatic events among resettled refugees.  

If the trauma is untreated, it can manifest as physical and psychological problems, Agha explained. 

“An individual may have symptoms including, but not limited to, nightmares, insomnia, anxiety, depression, flashbacks, anger, irritability and hopelessness. The risk for use of alcohol or drugs as a coping mechanism is also high,” she said. 

That might have an impact on a whole family, creating a risk of intergenerational trauma.

“Refugees are remarkably resilient and most of that resilience comes from within,” Agha said. “We can foster it by providing the right resources, including not only support for health and mental health needs but also those that will enable them to thrive socially and economically and improve outcomes for refugees and their families.” 

Targeted community

As Arzish struggles to put his childhood fears behind him, the hits to his community abroad just keep coming. This year, 10 Hazara coal miners  were pulled from the mine by unidentified gunmen, taken to a nearby mountain and shot dead in the Balochistan region in Pakistan. In January, a Hazara girl’s school was attacked in Afghanistan and 90 girls were killed. In October, there were two consecutive attacks on Shia Hazara mosques where more than a hundred deaths occurred.

Like other Hazara refugees, Arzish is grateful to the U.S. for providing him a new home. But like other refugees he has constant worries about relatives on the other side of the world where, he explained, they are a target often just because their faces place them in the Hazara community. 

At several points, in Quetta, Pakistan, the Hazara community went to extremes to protest the violence against them. 

Shows a line of coffins in the road each covered by a cloth, with people sitting near them, huddled against the cold.
Photo taken in Quetta, Pakistan, after dozens of Hazara were killed by bomb blasts. Members of the community refused to bury their dead, instead sitting next to the bodies for three days and nights as a form of protest against the Pakistani government which they believed had not protected them from attacks from Sunni Muslim groups. Photo credit: Ashrafghaffari/ Flickr Creative Commons

“My community … put their loved one’s dead bodies on the roads in a freezing temperature for many days to seek justice from the Pakistani government,” he explained about protests that occurred in 2013 and again in 2021. ”In Afghanistan, my community is unable to launch a protest in front of the Afghan government.”

Arzish explained that it was an unbelievable opportunity to escape from the horrible situation in his country and come to the U.S. Even so, he found himself staying away from social media because the heightened persecution of his community was painful to read about. 

“I stopped thinking [of] myself as a Hazara, even the word of Hazara brings a bitter taste in my mouth,” Arzish said. “I don’t  know how to explain, its sound [is] very unpleasant because any time in my recent memory this word comes up [it is] always associated with murder and bloodshed of my innocent people.”

Nonetheless, it can be impossible for Hazaras resettled in this country to completely avoid this type of news. 

“My inclination was to run away and forget those painful years of my life,” he added. “I am lucky to be granted asylum in the United States, a place where I can pursue my passions and dreams.”

What can help

Josh Hinson, program director of the UNC Refugee Mental Health and Wellness Initiative, said recently that many refugees express concern about employment, housing and health care. So part of the support provided by the initiative includes focusing on those issues. For example, the center refers refugees and other immigrants to immigration attorneys who can help with family reunification. 

“UNC Refugee Mental Health and Wellness Initiative partners with refugee resettlement agencies to help refugees connect to supportive services,” Hinson said. 

He added that “stressors for refugees may include adjusting to life in a new country, learning a new language, and concerns for loved ones in other countries”. 

Staff is trained in motivational interviewing, cognitive behavioral therapy and other evidence-based treatment methods for helping refugees and immigrants cope with stress and adjust to life in this country, Hinson said. 

Since 2013, Hinson said, his program has assisted 500 refugees, including families, couples and individuals. 

Hinson said the center’s state and federal funding restricts them to serving refugees who are in the United States for fewer than five years. But he said that often refugees need those mental health services beyond that time window. Individuals who receive services are rescreened after three months to determine how well they’re doing. Hinson’s staff also asks qualitative questions, such as what additional services they need.

Sometimes the program receives grant funding so counselors can work with people no matter their immigration status. Another limitation is whether the program has enough funding for interpreters who have been specially trained to work with people who have mental health problems. 

The center also uses other forms of help beyond talk therapy. For example, the Art Therapy Institute of NC provides services to children in Orange County, Wake County and Durham County schools, said Hinson.

There are few services such as the initiative at UNC-CH that are so specifically tailored to refugees in North Carolina. Though the state Department of Health and Human Services State Refugee Office and US Office of Refugee Resettlement Refugee Health Promotion have helped fund the initiative, Hinson said the program has the potential to do more.

“With additional funding, the UNC Refugee Mental Health and Wellness Initiative could train other mental health providers to serve refugees, and could subsidize the cost of interpretation,” added Hinson.

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Nadia Batool Bokari is a Columbia University graduate, freelance journalist and TV anchor from Pakistan. She has over a decade of international reporting experience, often focusing on issues of social...