Fear as a constant companion 

It is evening in the Pakistani capital Islamabad. It just rained so hard that many sidewalks and streets are no longer passable. As fast as the downpour came, it disappeared again. Fozia Mughal is walking hurriedly through the fresh air to the Faisal Mosque. When she arrives, the setting sun bathes the sky above the minaret in a pinkish red light. Fozia takes her sandals in her hand and climbs over some puddles and up the steps to the inner courtyard of the mosque. As the muezzin's call begins, she pulls her scarf tightly around her hair.

Fozia is in Islamabad for a visit. She is a psychologist by profession and works in Quetta, over 900 kilometers south-west of the city. With one million inhabitants, Quetta is the largest city in Balochistan province. It is located in the border area with Afghanistan where the Taliban and other Islamist groups are active. 

"So many bombs are going off in Balochistan that it is often no longer newsworthy in other parts of the country," said Fozia. 

For journalists working there, everyday life in this environment is tough. Many are left by their editors to cope with traumatic experiences alone. They often become so ill that they can no longer work. As the attacks in Balochistan increase, more and more organizations are withdrawing from the troubled province. 

One of the few actors still on the ground is Individualland. The Non-Governmental Organization (NGO) continues to work in conflict regions in order to advance peace-building projects there. Together with the DW Akademie, Individualland made the opening of the trauma center in Quetta possible. Since 2018, media professionals who suffer from severe trauma and are often barely able to do their work are offered free psychological counseling. Fozia is employed in the trauma center as a psychologist and provides urgently needed consultations. 

Fozia is planning to meet the director of Individualland in Islamabad tomorrow to talk about the project. As the muezzin's call fades away. She walks back towards the street, slips on her sandals again and smiles for a quick selfie. 

Sleepless, depressed, angry 

"Most of the reporters who come to me can no longer concentrate. They suffer from insomnia, they are often depressed, often full of anger," Fozia explained, adding that some men get upset very quickly and can even beat their wives or children. 

"I once had a client who told me that he freaked out when a cup wasn’t exactly where he put it," she said.

In the trauma center, those affected learn to recognize their psychological stress and to take it just as seriously as a physical illness and to address their situation. 

In Reporters Without Borders’ 2019 press freedom ranking, Pakistan ranked 142 out of 180. 40 media workers were killed in Balochistan province in 2016 alone. They are not only exposed to terror—the consequences of a long-running guerrilla war and accompanying violence—but also to threats, intimidation, contempt from their employers, fierce competition, and insecure employment conditions. 

In the strictly traditional Balochistan, it is difficult to understand how power structures work, even for locals like Fozia. Journalists must be very careful what they write in order not to become the target of various interest groups, such as the military, local government, police, or individual tribal leaders. For reporters, this means that stress and fear are their constant companions.

The counseling office at the trauma center is open from 9 am to 5 pm. Two psychologists work here: 48-year-old Fozia and her younger colleague, Sadia Ishfaq. During the first consultation they try to first find out whether the client is already suffering from depression. 

The clients at the center are mostly men as there are more male journalists in the province than female journalists. But they all enter carrying a heavy weight filled with insecurities and fears. 

"They are afraid of dying in a bomb attack. They are afraid of the power of the local government, the military and individual tribal leaders. They are afraid of stepping on someone’s toes with their reporting and being threatened afterwards. They are afraid of losing their jobs and not being able to feed their families," said Fozia.

Fozia understands this kind of existential stress. In Pakistan she is a so-called "settler," the name given to people whose families immigrated, often many hundreds of years ago, mostly from India. Even today this minority is not really accepted. Her father, a simple day laborer, wanted his daughters to succeed and saved every cent he could for their education. Fozia studied as did her sisters. This led to some whispers among their neighbors when the sisters were looking for work after their studies. In male-dominated Pakistan, where even women with doctorate degrees often stay at home if their husbands so wish, this was not the normal course of action. 

"My father just ignored that. He used to say, 'Do exactly what you want to do, but do it with a sense of awe and respect'" said Fozia. "When I started to look for work in 1996, I would never have gotten a job in the public sector as a 'settler' so I applied to international organizations."

Help when they can’t take it anymore 

Islamabad is divided into a grid of squares. Instead of names, streets have numbers. In F6 district there is a central market and many restaurants. Sitting in a Turkish restaurant that is considered an insider tip, Fozia orders flat bread and kebab. She is looking for photos of the trauma center in Quetta on her mobile phone. It is located on the ground floor of a two-story apartment building painted light yellow. Fozia shows a picture of the waiting room where two heavy brown leather armchairs invite visitors to sink in and relax. On the table in front of them is a carafe of water and next to it lie some handkerchiefs. Fozia's treatment room is located in an adjacent room. From her desk, she looks out over an alley. Those who want to remain unseen can also enter Fozia's office directly via a side entrance. 

"Here you are still quickly labeled as 'crazy' when you go to a psychologist,” she explained. That's why the office’s sign, flyers and brochures say "media center" and not “trauma center."

Discretion is an important aspect of Fozia’s work. For her and her colleague, it goes without saying that the identities of the affected persons must remain under lock and key. The two of them arrange their consultation appointments in such a way that media workers seeking help do not meet each other. In the beginning, the center had to do a lot of work to educate their target group. Fozia often heard: "I am already taking pills for my insomnia. Why should I seek counseling?" Many journalists in Balochistan often didn't even know that psychologists approach things differently, that talking, analyzing, and changing behavior can lead to healing. 

"Most of them only come when they just can’t handle it anymore, for example when they had to report on a bomb attack and could no longer bear the sight of torn-up bodies," said Fozia. "Bombings are often the straw that breaks the camel’s back."

Two strong women, one mission

The next morning in Islamabad is humid and hot. The capital city lies in a basin and in the morning, when the traffic is still calm, the screeching of wild monkeys, the chirping of birds, and the bleating of goats can be heard. Islamabad is a very green city and by Pakistani standards, very safe. Almost every street in the city center is lined with trees and on main roads there are surveillance cameras every 100 meters. 

Fozia calls a taxi. She is wearing black pants, a richly embroidered dress and a matching scarf on her head, typical attire for women in Balochistan. The taxi takes her past modern shopping centers, tea rooms full of men in long robes, and street vendors selling Pakistani flags, colorful flowers, and spicy chips. Fozia gets out in front of a big gate on a dead-end street. She is there for a meeting with Gulmina Bilal Ahmad, the director of Individualland.

In the meeting room, the air conditioning hums. A parakeet squawks outside the window. Just like Fozia, Gulmina is a trained psychologist and just like Fozia, she is a woman who is not afraid of asserting herself. 

"My parents wanted me to study medicine just like my brothers. They sent me to university for an entrance test. I just handed in a blank sheet and failed," she said. 

For a month her family did not talk to Gulmina, then they accepted her decision to study psychology. Later they supported their daughter when she spent a few semesters in Australia working with drug addicts and imprisoned women before returning home to start a career in development aid. 

"As working women, Fozia and I belong to a still small minority, which is growing steadily. If you look at history, you can see big changes often begin with small steps," she said. Their commitment to a peaceful Balochistan also unites the two women. Like Fozia, Gulmina's family—at least on her father's side—comes from the province. 

"In Pakistan people talk a lot about Balochistan. But they only talk about the province, instead of talking with the Baloch themselves. Their voices are not sufficiently represented in the media," Gulmina recounted. While Fozia is reserved and quiet, Gulmina's voice fills the room as she talks about Pakistan's large media houses, which are based in Karachi. 

"The editors there have no idea about geography, and they don't do their own research. They call a stringer in Quetta and tell him to go to a location immediately and deliver an article in 30 minutes," she said. Such demands are often impossible as attacks take place a long way from Quetta. Even with a helicopter, reporters could not make it to the site on time. 

But even if the stringers manage to get to the site in time, she explained, they often try to do the impossible so that they can keep their jobs. Ultimately in these situations, they are left to fend for themselves by their editors.  

Gulmina sits down again, takes a deep breath, and leans back. She could go on for hours about the ignorance of Pakistani media houses, about the traditional understanding of respect that forbids reporters to contradict their superiors and about the importance of strengthening and protecting media professionals. 

Disputes are not always regulated by law 

Fozia scrolls through pictures of her hometown of Quetta. In the background, barren mountains can be seen. Where the shadow falls, they are dark grey but where the sun hits them, they glow in an earthy, ochre yellow. On the clayey roads, fully veiled women in dark burkas walk alongside others colorfully dressed with a scarf loosely wrapped over their hair. The men wear long white, beige, or grey robes. Some wear a round, crocheted prayer cap. Others have elaborately wrapped turbans. Soldiers with their military fatigues and shouldered weapons can often be seen walking amongst the residents. 

Balochistan is not only a troubled region; it is also a strictly traditional one. Whoever conducts interviews there must know which district he is reporting from and which ethnic group lives there plus the rank and political affiliations of the interviewee. It is also important to know whether the interviewees belong to an outlawed minority or whether they have contacts with the police, the military or associates of a feared tribal lord. 

"You can't just walk in somewhere as a journalist and start working," explained Gulmina. "You have to know the context. You have to know how to ask questions. You have to know who to kneel before respectfully instead of just shaking hands. If there is a dispute, it is not always settled according to the law. They settle it in tribal fashion." 

All these questions of proper handling and preparation are additional stress factors for reporters. Gulmina and Fozia divide Balochistan's media professionals into three groups. The first category is the permanently employed. They are members of the local press club, have genuine press credentials, and often work in the local bureau of a large media company with headquarters in Karachi. The second category consists of reporters who regularly work as stringers for two or three media outlets, often international ones. The third category is the largest and the weakest: reporters working from home on a freelance basis. 

"They have to deliver between 15 and 30 reports a day to survive financially," explained Gulmina. "You can’t research up to 30 topics a day. Both the audience and journalistic quality fall by the wayside."

Learning new ways to deal with stress 

In order to reach the many freelance journalists who are not officially registered, Individualland and the trauma center are launching a large-scale campaign. Using newspaper, radio, television, and online reports, they try to find the names of reporters and send them a letter with a flyer of the trauma center. 110 letters have been sent out so far. The groups hope that the journalists will be open to psychological services as media houses do not offer any level of counseling.  

"Some editors say [stringers] are a dime a dozen. They are considered dispensable," said Fozia, adjusting her reading glasses. An older editor-in-chief once told her that if a reporter cannot cope with the situation here, if he has a problem putting on a protective vest and strapping a gun to his leg, then he'd be better off opening a shop. 

Andeel has experienced exactly the same reaction (Andeel's real name remains anonymous). After working on a story, he was followed by members of one of the groups he was researching. In the middle of the night, the phone would ring several times. When he picked it up, he would hear heavy breathing then the caller would hang up. When he told his boss about it, he was told that he was free to look for another job. Andeel reacted with panic attacks and manic fears that he was being followed. He chewed his fingernails down to the skin and thought every person he passed on the street was out for him. He was often too scared to even answer the phone.

"With the psychologist I analyzed my situation and learned to deal with stress in a new way. I now know that I alone cannot change society, I can only change myself and my behavior," said Andeel. 

Many of those who seek advice at the trauma center are in the same situation. Often the sessions can change not only the perspective of the journalists, but also that of their families. 

"One of my clients came alone first. His wife wanted a divorce. She found him unbearable because he was constantly irritable," said Fozia. "At some point she came too. I first had one-on-one conversations with both of them and then started couple's therapy. Now they want to try to stay together."

A sense of achievement

Fozia does not need expensive advertising to draw attention to the trauma center. So far, word of mouth has worked so well that not all those seeking help can be accepted. 

"There are always requests from people who do not work in the media. We try to pass them on to other counseling centers because we concentrate specifically on journalists," she said. 

In order to reach those who live far from Quetta, Individualland has published two booklets that are available on its website. The first is a handbook on psychological counseling for reporters with tips on recognizing psychological stress. It includes a glossary of terms explaining, for example, the difference between psychiatrists and psychologists or between a depressive episode and depression. The second is a listing of addresses of counseling centers.

So far, two non-governmental organizations in Pakistan have been working on behalf of the mental health of media workers. In Karachi, the Center for Excellence in Journalism, which is attached to a university, offers journalists free professional advice. In Quetta, this task is carried out by Individualland. Both are partner organizations of DW Akademie and started to offer trauma counseling in February 2018. They work directly with those seeking help and also approach media outlets to provide them with information about work pressure, conflict experiences, and trauma. 

In order to protect media workers in the long term, Fozia and Gulmina want to better involve responsible editors and administrators at media outlets. Only when they understand their reporters’ need for more support will their work conditions improve. Both believe that balanced, reliable reporting and psychologically stable employees often go hand in hand. 

This is also the experience of Rasheed Baloch, head of the regional office of the GNN television station in Quetta. He appreciates the work of the trauma center.

"Many of our editors and media managers don’t understand the term 'mental health,'" he said. "One hundred percent of journalists are under stress when they are reporting. Once they have gone through a counseling session themselves and notice that they feel better afterwards, they will also actively support such consultations."

Fozia and Gulmina will expand their psychological persuasion into the executive offices. That way, Andeel and his colleagues in Balochistan will have better access to counseling so they can learn how to not only accept their problems but also how to deal with them. 
Only when the evening sun sinks again and the muezzin finishes his call to evening prayer do they finally turn off the light in the meeting room.

Author: Petra Aldenrath loves to write portraits and long-form articles. She is an experienced journalist who has worked for newspapers, magazines and radio and has been published in several books. For five years she was the ARD correspondent for Mongolia and China. She has also worked as a freelance reporter from Australia, Indonesia, Vietnam, Canada and Israel. She has been working at the DW Akademie since 2018. She is particularly interested in telling the stories behind the organization's diverse media development projects.

Profile: Pakistan 

Who? 

• The NGO Individualland runs a trauma center for journalists in Quetta, Pakistan.  The Center for Excellence in Journalism at the Institute for Business Administration (IBA) advises traumatized media workers in Karachi. 

How does the project work? 

• The trauma centers offer free psychological counselling for media workers who are often severely traumatized by terror, violence, intimidation, and extremely precarious working conditions. 
• The trauma centers also contact the media outlets directly to raise awareness that mental stability is as important as physical health and that psychologically stable journalists deliver better quality work in the long term. 

What are the difficulties? 

• Balochistan province, where the city of Quetta is located, is affected by targeted attacks by Islamist terrorist organizations and separatist groups. In addition, the military and the security services, as well as tribal chiefs with different interests, make Balochistan an extraordinarily difficult and dangerous environment for journalists.
• Media houses do not properly protect their journalists or not at all. Instead, they are often regarded as easily replaceable workers. 
• In addition to the psychological burden of reporting on terror and violence, journalists are also afraid of competition, job loss and insufficient earnings. 

What has the project achieved? 

• The project has succeeded in making psychological stability a topic for media professionals and in bringing depression, trauma, and burn-out out of the shadows. With their work, the trauma centers have triggered a discussion in the professional public. 
• Psychological consultations have helped clients to change and regain control of their private and working lives. In total, about 200 people seeking help have since been counselled, about 70 of them in Quetta. 

What are the highlights?

• Both trauma centers have received very positive feedback. In Quetta, a newspaper published an article about the work of the trauma center. 
• In order to reach media professionals who work far from Quetta, Individualland has published two booklets: a handbook with tips for and explanations of trauma, stress, and mental health and a directory with addresses of counselling centers.