Figures for the number of deaths and civilian causalities fail to capture the much broader and wide-ranging implications of drone warfare in Pakistan. The Bureau of Investigative Journalism tells us, as of today: a total of 381 drone strikes has caused anywhere between 2,412 and 3,701 deaths; including between 416-951 civilians and 168-200
 children. Sure, it gives us a picture of the destruction caused by drone warfare in Pakistan, but unfortunately physical trauma is only one aspect of modern warfare. Popular analysis of drone warfare has consistently overlooked the psychological impact of drone strikes: that of the widespread mental health problems that have impacted the lives of residents in North Waziristan and beyond.

The Inadequacy Of Surveys

Surveys so far have failed to account for the psychologically affected victims of drone strikes. Some charities, such as the UK-based Reprieve, have made valiant and laudable efforts to document drone deaths and their study, “Living Under Drones” does go some way in detailing the plight of locals. However, very few other substantive studies exist that attempt to determine the number of those suffering from mental health problems in the aftermath of drone warfare. The closest we have come to capturing the underlying psychological repercussions comes from observations made by Dr. Mukhtar-ul-Haq, Head of the Psychiatry Department at Peshawar’s Lady Reading Hospital, who notes that the “rate of depression is really high in Waziristan.”

In an effort to better understand the issue, I spent the summer of 2013 conducting research in collaboration with a government run mental health clinic in Islamabad. The hospital, like others in the city has seen a recent influx in the number of psychologically affected victims of drone strikes and I approached a number of these hospitals to interview patients. There I spoke with some fifty patients suffering from Post Traumatic Stress Disorder and insomnia amongst other illnesses. The conversations I had with the victims and their families were incredibly revealing and the narratives and stories they shared with me showed what is truly at stake.

Troubled Tales: “Worse Than Death”

 “Worse than death” was how one of the first victims I interviewed described the situation. Asif, a father of three and native of Miran Shah (a town in North Waziristan), reported being perpetually scared of drone strikes and spoke of a “murky, saddening and constant” fear of death. He said “my family and I lived in anticipation of death for many years before we decided to move to Pindi; its not home but its better than death.” Especially after his eldest son’s death in a 2010 attack, his three sons, four-year-old daughter and wife had suffered bouts of emotional trauma and anxiety, which often manifest themselves in headaches and insomnia. The problems Asif and many other patients spoke of are not rare occurrences nor should they be seen as unexpected. The drone conflict inculcates a wartime atmosphere in the tribal regions of Pakistan. Sometimes drones have often defied international humanitarian laws adopted under Geneva Conventions by repeatedly targeting civilian gatherings and first responders rushing to help the wounded. As such, the mental health problems we see in North Waziristan are similar to those observed in other areas around the world that have suffered from prolonged wars; such as during the protracted Iraq/ Iran war and the Israel-Palestine conflict.

My supervising officer, a consultant psychiatrist and Head of the Department of Mental Health explained this as an outcome of “helplessness” and “unpredictability” brought about by drones. He notes that the symptoms are comparable with the psychological trauma resulting from torture, with “uncontrollability” a common trait.

Moreover, the psychological effects, at least in part, are symptomatic of a dramatic shift in life styles brought by the fear of drones and a constant state of war. Families have pulled their children out of school and people avoid otherwise common activities like shopping and farming. As one my interviewees, Amer, put it “when more people are together, they have a chance to kill more in one strike. Knowing this, how can I send my fifteen-year-old to play football with other kids?” Taylor Owen, the research director of the Tow Center for Digital Journalism at Columbia University, describes this behavior as characteristic of “anticipatory anxiety” – a psychological phenomenon that causes people to worry constantly about their immediate future.

This transformation in lifestyle is perhaps even more dramatic for those who have chosen, though unwillingly, to abandon their ancestral homes and seek a safer environment elsewhere. Migrants, like Sheroz (an office assistant at the hospital) suffer from problems of adjustment and what may be comparable to a “culture shock.” Central Punjab and the tribal areas have little in common and although officially tied by a common national language and sworn allegiance to the same flag, the two areas offer very different socio-cultural customs. Sheroz explains how he has been unable to send his daughters to school and how he has struggled to adapt to this “artificial and too-fast-for-its-own-good lifestyle” in this big city. With an unmistakable longing and sorrow in his voice, he revealed how his wife struggled for two years to get used to the new city and new life, before finally being admitted to a local hospital as another psychiatric patient.

US Army Drone via Wired

Socio-Economic Effects

It should then come as no surprise that the socioeconomic effects, though undocumented till now, are undoubtedly vast and penetrating. However, it must be conceded here that the region was underprivileged and underdeveloped to begin with. Other than some efforts by Zulfiqar Ali Bhutto’s (Pakistan’s 9^th Prime Minister) that included the establishment of the FATA Development Corporation (FATADC) in the 1970s and the subsequent expansion of educational institutions and federal jobs in the area, the economic development of the tribal areas has often been overlooked. According to most reports, the Federally Administered Tribal Areas though home to almost 2.4% of the population constitute less than 1.5% of the economy.

Although the region was already neglected economically, the recent safety and security situation, a product of militancy and drone warfare, has made development even less likely. Note for example that the mining of commercially viable reserves of marble, copper, limestone and coal in the region, which could have brought ample economic resources and business to the area, has had to be halted. Similarly, NGOs whose involvement is vital in the reconstruction and provision of basic social and health services, have been largely restricted and their activity curtailed, because locals now see them, as Ijaz Khan, an International Relations Professor at University of Peshawar, put it “as foreign agents promoting Western and U.S agendas.”

This is perhaps because people are often unable to appreciate the distinction between the US government that sponsors drone strikes, and international NGOs that simply aim to rectify the damage. This, at least, seemed to be the impression I gathered in my interviews, where foreign elements were often dismissed as either American or not American. The link here seems to be this: drone warfare inspires hatred and distrust of foreign actors that can impact on the ability of NGOs. This, coupled with a reduced viability of successful business operations, means a diminished chance for economic success. While I concede that we need much more information to be able to confidently determine this proposed link to economic detriment, it should be evident that drone warfare has damaged the local economy in more ways than one.

Similarly, the fate of those who migrate has been a story of continual economic struggle. It was easy to conclude from my interviews that a majority of those who have moved to central Punjab have either struggled to find adequate jobs or fulfil theirs roles; if they have even been able to find one. Almost 30 of my 50 patients had taken to one of Pakistan’s lowest paying and highly unreliable day-to-day job: that of Mazdoori (construction work). If the Mazdoor is able to find a contractor in the morning, the wage could be anything between 75 cents to 3 dollars a day; barely means for subsistence.

Further Radicalization 

The American attitude of “we’ve got this, guys” is in part based on this obliviousness: a failure to note how the psychological damage may play out. It seems that the State Department is yet to acknowledge the radicalizing effects of drones, as air strikes still continue in Pakistan, While this radicalization comes in all shapes and sizes, instigated by various channels, emotional or otherwise, I invite the reader to consider two simple, but very likely scenarios that go some way to highlight the dynamics under discussion.

In the first scenario the wounded and psychologically affected take the death of their brothers and fathers as sanctioned by God. They pack their belongings and migrate out of their ancestral land; a difficult but widely practiced option. These are the people I documented.

The second option involves family members developing a thirst for revenge so that they seek avenues and agencies that facilitate violence against the enemy. Not that unlikely given that the tribal culture in North Waziristan, while discouraging violence, does allow for revenge. Active recruitment by the Taliban and the potential for drones to aid this recruitment makes radicalization even more likely.

Conclusion

 Admittedly, it is not easy, in any sense, to sufficiently document a phenomenon as broad as the damage caused by drones. True. But, if you just nodded at the last sentence, take a minute to notice the irony: if we cannot capture, explain or attain a better idea of this vast and diverse damage caused by drones, then how we can really expect to “understand” the issue under question? Isn’t our figure-centric knowledge only a trivial recognition of the vast repercussions of the conflict? And perhaps most importantly, how can we inspire and mobilize popular dissent for drones when the real significance of the issue has remained and remains hidden?

Note: All names in this article have been changed to keep anonymous the identity of those interviewed.