In 1989, the Institute of Mental Health and Neurosciences in Srinagar recorded roughly 1,700 psychiatric outpatient visits annually. By 2015, that figure had reached 100,000. The woman who should be among those 100,000 is not. There is no psychiatrist in her district. She carries what the militarization gave her: house raids, a disappeared husband, years of curfew, and no clinical support, because the state that produced her condition never built the infrastructure to treat it.

The scale of need is not in dispute. The 2015 Médecins Sans Frontières survey across all ten districts of the Kashmir Valley, covering 5,428 households, found 45 percent of adults showed symptoms of significant psychological distress, with 93 percent reporting at least one traumatic event and an average of eight each. The 2017 Housen et al. study in BMJ Global Health confirmed these figures and established a dose-response relationship: each additional traumatic event measurably worsened depression, anxiety and PTSD.

The scale of response has not matched it. Indian-Occupied Kashmir has 41 psychiatrists for 12.5 million people, one per 300,000, ten times below the WHO minimum of three per 100,000. Eleven of twenty districts have no psychiatrist at all. The 2016 ActionAid and IMHANS survey found only 6.4 percent of those with serious mental health conditions had ever seen one, a treatment gap of 88 percent.

Indian authorities maintain that governance has improved since the 2019 abrogation of Article 370 and that security operations are necessary counter-terrorism measures, not sources of civilian harm. That position cannot account for a trajectory that preceded 2019 by three decades and has continued since. Suicide attempts rose roughly 250 percent between 1994 and 2012, per the Indian Journal of Psychiatry, and by 2022 Jammu and Kashmir led all Indian states in recorded attempts, National Crime Records Bureau data show.

Stigma is real, but it does not fully explain the gap. Nearly 90 percent of Kashmiris with mental health conditions never seek formal care, citing fear of social labelling. Stigma operates within a civil society space the state has itself constricted: the journalists, human rights defenders and community organisations through which destigmatisation campaigns function elsewhere have been suppressed under the Unlawful Activities Prevention Act and the Public Safety Act. The gap is stigma compounded by the removal of the infrastructure that ordinarily reduces it.

The consequences compound. UNODC data indicate approximately 600,000 residents have addiction issues, an increase researchers link to untreated trauma in a population carrying acute psychological injury with no professional care available.

What exists deserves honest assessment. The government’s Tele-MANAS helpline, launched in 2022, has logged tens of thousands of calls, and groups like Kashmir LifeLine provide counselling and school programmes. These are genuinely valuable, and also the equivalent of first aid kits at a mass casualty event whose hospital was never built. WHO and MSF evidence from Palestine and Afghanistan shows that community models using the mhGAP framework and trained lay workers can close treatment gaps without proportional specialist expansion. Indian-Occupied Kashmir has not deployed them at scale.

The legal obligations are specific. Under Article 12 of the International Covenant on Economic, Social and Cultural Rights and General Comment 14, states must ensure the highest attainable standard of mental health and must not pursue policies that systematically harm it. India’s own Mental Healthcare Act of 2017 guarantees a right to community-based care. The 2018 OHCHR report to the Human Rights Council, document A/HRC/39/47, documented the psychological toll of disappearances and called for accountability, and the CEDAW Committee has separately urged gender-sensitive support. The Jammu and Kashmir State Human Rights Commission and the National Human Rights Commission have both acknowledged the crisis. The acknowledgment is institutional. The implementation is not.

The woman who should be among those 100,000 outpatient visits is still waiting. Thirty-five years of documented need, institutional acknowledgment and inadequate response. A state that generates trauma through its own security architecture, documents the consequences, and directs resources elsewhere is not administering a healthcare failure. It is administering a choice. The 88 percent treatment gap is the measurable shape of that choice, and the 1.8 million adults still carrying significant mental distress without access to care are the people living inside it.

The author is a graduate in International Relations from the International Islamic University, Islamabad and is currently serving as a researcher at the Kashmir Institute of International Relations, Islamabad.