_{Abridged version, which was originally written for The Rights Collective. Please see here for other blogs in The Rights Collective series.}

When it is my time to go, My Love, do not be afraid,

Scatter me amongst tea leaves bright as jade,

Allow my fragrance to move from the earth to heavens above

Take me in your hands and remember how we almost fell in love,

Crossing the mountains and rivers of two nations we met

I am here to remind you of your promise ‘lest you forget,

You vowed to let the laws of Mother Nature be

And when time comes that you will set me free

So, when it is my time to go, My Love, do not be afraid,

Scatter me amongst tea leaves bright as jade.

It is true, that my life was born out of the violent struggle that was soaked in my mother’s viscous blood, yet in some ways, it has been the many shades, fragrances, textures and tastes of tea that have carved out the essence of my being. Over countless cups during this life, tea has been the sole witness to the friendships I have nurtured; it has brewed patiently to watch me slowly fall in love; it has comforted me as my heart broke; it awaited my return as I ceased to exist and so far it has fulfilled an unspoken promised to remain my sole companion as the life continues to accumulate fragments of joy, sorrow, pain and hopefully, healing.

There are over a thousand different types of tea, and even more varieties that my imagination can conjure. Even the same type of tea can have several blends and different methods of preparation. Similarly, the experiences of my life have been silently witnessed by such different teas – each with its own aroma, its own taste and its own lessons and certainly its own set of memories etched into individual neurons that fire away and light up my brain as a small meteor shower lights up a dark sky.

The most primitive memory and the fundamental basics of my introduction to tea has been the elaichi chai that I have seen my mother prepare. Chai has been the most serious of family business and has often bordered on obsession. From the naashta to shaam, this chai has been a moment of temporary respite, almost like an addict taking that one final hit of a euphoric high. I have grown up listening to Ammi describing it as her nasha – an inexpensive but loved habit passed through to each household member as their virsa. Black tea leaves are placed in a well-used and tired pan and brought to a boil. Once the water reaches a bubbling essence to it, freshly ground elaichi powder is added leading the tea leaves to sizzle frantically before eventually settling down. Two minutes later milk is added and the concoction is tested against the Celsius until it comes to a boil, then simmered for a further few minutes before being decanted into a kaitli, and eventually finding way into a trusted worn out mug that is old enough to be classed as a family heirloom. Elaichi chai has shaped my ethics, values and perhaps even the backbone of my existence; through it I have seen, felt and tasted love, tradition and ritual.

My first flavour of subtle, fruity and fresh tea was through a fine blend of Darjeeling, otherwise known as the champagne of teas. One spoon of whole tea leaves line my glass pot to which I add water just below boiling point and allow them to dance freely in their chaotic surroundings, almost like a whirling dervaish. Do not let the subtle taste of this tea fool you into thinking it is weak. The Darjeeling is the foundation of my definition of friendship and love; it has seen me come of age, it has encouraged me through trials, it has held me as I broke down and it has been my sole cheerleader whenever I have found myself against the tide. The Darjeeling is deeply rooted in my existence and understanding of who I am; without it I am rudderless and without direction. To lose sense of the taste, texture and aroma of this tea is to essentially lose sense of my being.

There are other teas that are also worthy odes to friendship of which one is Cha Yen, Thai Iced Tea. Made with a black tea blend including orange blossom, star anise, tamarind seed and rich orange colouring, this tea is completed with evaporated and condensed milk to be enjoyed over ice. Cha Yen is equally fun to prepare and consume and it often transports me to the best years of my life that were full of laughter and life. Whilst I am left with fragments of those memories that sometimes feel like they are slipping away, it is a comforting thought to know that there is someone from my previous world who always stands by my side in vigil; continuing to teach me all that I need to know of light, darkness and dreams; Zamindar.

Then of course, one that is very close to me and my contribution to a weekend chai ritual that Ammi and I share; adrak chai. Prepared similarly to the elaichi chai, this boasts the rich aroma and hit of ginger to the tastebuds. The somewhat subtle aspects of this chai are universal in their encapsulation of a world of memories. Whether it was concocted by Rajni didi in Haridwar or my adopted Noidian-Garhwal family; consumed by the roadside kulhar after kulhar in Benares or required as a defibrillator on a fateful (rather, fearful) drive with Priyam and Dilshad Sahab Agra Walay – the adrak chai evokes a nostalgia and a longing to go back, which is always stronger than before each and every time.

Moving back to the British turf, I come to the Earl Grey. This tea is almost like the elixir of life – tempting, gratifying and royal. Prepared similarly to the Darjeeling, it is a sweet tea boasting rounded hints of bergamot. Its disposition on the surface is amenable, but it can also be fickle and at times no less than a series of trials, tribulations and battles destined to be lost. The same method of its preparation has sometimes yielded one of the most exhilarating experiences of a sweet, well rounded and delicate taste. But the Earl Grey also denotes betrayal and heartbreak. The mighty varieties, blends and mixtures of this tea have been a labyrinth where I have previously lost myself. The Earl Grey has also been cruel and left me banished from the land of tea and everything I know of it. And thus, I have to remind myself to remain cautious in indulging in it for time has often demonstrated to humankind that histories can repeat themselves.

Nevertheless, I eventually came out of the labyrinth and back to tea with a vow to not leave it again. However, there is one variety of tea that I am not ready to face, and that is the rich and deep. I shall not name the tea as we both are not ready to face each other just yet. However, I can tell you that it is the only tea that I have never prepared, in fact it was always prepared especially for me. This tea marked the intensity of life, both good and bad. The fine-tuned earthy and smoky aroma, not too dissimilar to lapsang souchong, taught me the responsibility that comes with being someone’s entire world; of what it means to love and be loved; and, what it means to lose, to grieve and to break.

Not all tea has a dark and black colour, though. And here comes Noon chai, otherwise known as Kashmiri pink tea. It has an earthy fragrance and salty taste that takes me to a special winter in Srinagar. It evokes the nostalgia of late night talks, laughter and being somewhere between home and not home. The rich pink colour evokes a sense of temporary stillness as I liken the rosy colour to the land’s flora in spring, however, soon it dawns on me that it remains some shades light of deep rouge that brings a sense of shame and guilt by association. The struggles of a people, community and its nation flash before my eyes and remind me of being complicit in their suffering.

Oppression, power hierarchies and the national drink

Whilst this humble beverage has shaped me to be the person that I am and stood loyally next to me as I have navigated and begun to come to terms with all that life has, and undoubtedly, will continue to hand out – I cannot hold myself in the same high regard and loyalty when it comes to tea itself. I have spent most of my life not questioning the source of my tea or considering the trials and difficulties of the worker who has worked hard for this taste to reach me.

The combination of oppression, power hierarchies and tea are not just limited to the traditional role of subservient women in the kitchen, but extend to the world we live in. The origins of this drink date approximately back to 2700 BC and through the slow fermentation of time, tea has found itself to be a staple ingredient across the globe. In fact, in India, Bangladesh, the United Kingdom, Egypt, Morocco and Tunisia, tea is the national drink. The humble leaf, however, has historically been associated with a murky past embroiled in politics, colonialism and exploitation of people.

Looking at the Indian example – Tea cultivation initiated in British India who broke the monopoly on the supply of leaves held by China. In 1830’s the British began with experiments of tea cultivation in the hills of Bengal and Assam. Through Tea, British dealers and the British Government were able to reach the planes of the Indian subcontinent, the Caribbean and the American colonies. It enabled the Raj to recover a slumping economy and boom Britain to financial riches.

In 2019, tea accounted for global revenue of approximately $215 million with an estimated growth rate increase of 6.9% until 2023. The demand for tea continues to grow as we nourish our bodies, beings and existence with this beverage. However, when it comes to issues of sustainability, there remains a lack of nuanced, meaningful and constructive dialogue amongst the average tea drinker.

Labour is the single most social issue that has not only threatened, but impinged upon the ethics of sustainable tea supplying. Taking the example of India, communities traditionally contributing to labour are often in incredibly oppressive conditions. Tea producers remain competitive in the market through the control of minimum wage, which is not sustainable to maintain a basic quality of life. For example, in Darjeeling the minimum wage is reported to be as low as $2. A report from the international development charity Traidcraft Exchange highlighted tea companies that trap female workers in a culture of surveillance and control by management. The housing is inadequate and sanitation is poor or non-existent that has often led to open defaecation when working. A BBC Four documentary focused on other abuses, which include child labour, controlled access to worker’s accommodation, exposure to harmful chemicals and adverse health outcomes secondary to chemical exposure.

Activists and charities have called upon tea companies to publish their list of suppliers and demonstrate transparency so tea estates can be held accountable for their treatment of workers. However, unless the average consumer is looking for this information and consciously makes ethical choices, there is ample scope for this to become another tick box exercise and loop hole, which continues in the systems of oppression.

So, there we have it. The journey through, with and in tea seems to have meandered more than I had intended for it on paper. As I glance at my empty teacup, I am trying to contend with all the emotions it has evoked through memory as well as some sense of resolve and determination in doing justice and repaying this drink for all it has taught me. My final transgression of this elementary understanding, dear reader, is to conclude with the philosophy of tea, with words that have encompassed all that I have to say, and perhaps even more so:

“Teaism is a cult founded on the adoration of the beautiful among the sordid facts of everyday existence. It inculcates purity and harmony, the mystery of mutual charity, the romanticism of the social order. It is essentially a worship of the Imperfect, as it is a tender attempt to accomplish something possible in this impossible thing we know as life.”

(Kakuzo Okakura in The Book of Tea)

Originally written for The Rights Collective. Please see here for this and other blogs in their series.

buzkushi / (bʊzˈkæʃɪ) /
noun
Translated as “goat pulling”, is a traditional game that is played on horseback or yak back where players vie for control of a goat carcass in an effort to score points for their team.

There is little difference between the goat carcass in buzkushi that is fought for, dragged across rugged lands and placed in a goal than the carcass of the idea that has become a “Muslim woman”. On second thoughts, buzkushi is perhaps less dangerous and arguably kinder to the carcass than society is to a Muslim woman who is oscillated between persecution and criminalisation in a bid to score points politically, economically, and socially.

The current cliched and accepted narratives of the Muslim woman rarely extend beyond two scenarios; the ones who are oppressed and subjugated by the evil Muslim men and those who are radicalised extremists supporting Shariah law and aim to bomb their way through the West.

These narratives exist not only in our social structures but are also deeply embedded within political frameworks responsible for the dichotomous approach of saving the oppressed Muslim woman whilst simultaneously disseminating policies that consolidate, institutionalise and give rise to wide acceptance of Islamophobia.

Muslims, Islamophobia and Impact

Islamophobia is “an exaggerated fear, hatred and hostility towards Islam and Muslims that is perpetuated by negative stereotypes resulting in bias, discrimination and the marginalisation and seclusion of Muslims from social, political and civic life”. The impact of this rather succinct and, dare I say it, aptly academic definition can be seen in attacks against mosques, graffiti on campuses, hate mail, verbal and physical abuse and discrimination in schools, universities and labour market.

Islamophobia is a multifaceted product of animosity towards race, ethnicity and culture. Xenophobia also perpetuates Islamophobia through the othering process of Muslims, who are perceived as outsiders not only ethnically but also through their perceived values and norms, which is directly translated as a threat to Western identity and way of life.

There are 2.8 million Muslims in the UK, which forms approximately 4.4% of the total population. Not only do Muslims work in key sectors such as the NHS which employs 29,200 staff identifying as Muslims, but they have also made significant contributions financially and socially e.g. contributing over £31billion to the British economy; raising £100 million charity in the month of Ramadan alone and providing approximately 70, 000 jobs in London through businesses.

The statistics for British Muslims do not bode well; e.g. 46% of Muslims live in 10% of the most deprived local authority areas, 26% of British Muslims have no academic qualifications, someone with a non-Muslim name is three times more likely to be offered an interview, and finally, Muslims have the highest disadvantage in the labour market leading to highest rate of unemployment and pay gap.

Gendered Islamophobia

Muslim women pay a “triple penalty” for being female, BAME and Muslim in the labour market; 1 in 4 employers are reluctant to hire Muslim women due to concerns they will place family commitments ahead of professional tasks and 1 in 8 Pakistani Muslim women were illegally asked about marriage and family values in interviews. In their personal lives, approximately three quarters of Muslim Scottish women have experienced Islamophobia.

Social constructs have depicted Muslim women through a foreign and distant lens, which has encouraged and validated their alienation whilst simultaneously enforcing changes that distance them from the ideological “Western society”. An example would be of David Cameron criticising Muslim women’s lack of English-speaking ability, which in his opinion led them to not assimilate in British society and remaining vulnerable to extremist. If one ignores the deeply problematic generalisation of Muslim women not being able to speak English or even singling them out to terrorism, then the fundamental question remains of why the former prime minister chose to cut the English language teaching budget by half.

The European political dialogue has aimlessly and confusingly besotted itself with “Islamic clothing”. This has ranged from formalised policies calling for and effectively banning burqas to our political representatives openly mocking Muslim women. Recent examples include Boris Johnson comparing Muslim women in niqab to letter boxes and burglars and Sarkozy defining the burqa as a “problem with liberty and dignity”.

In 2016 a Muslim woman was confronted by the French police on a beach and asked to remove Islamic clothing, whilst other citizens were applauding them and shouting, “go home”. This was justified by the authorities as the burkini was “liable to offend the religious convictions or (religious) non-convictions of other users of the beach”. I am struggling to find the dignity or liberty in this scenario, albeit I can identify the explicit contraventions of Article 9 of the Human Rights Act 1998, which protects one’s basic rights to freedom of thought, belief and religion.

Islamic clothing has also made cameo appearances on cat walks for the likes of Dolce & Gabbana etc. Ergo Islamic clothing is a symbol of oppression for the Muslim woman, however, at £1800 it has a tendency to become somewhat palatable, especially if the model donning it is a Caucasian non-Muslim. It is precisely this duality of standards, which is entrenched not only in the debate regarding attire but extends to other aspects of a Muslim woman’s existence whilst simultaneously excluding her from the discussion.

The ramifications of Islamophobia are amplified for women who bear the brunt of hate crime, which is often in public spaces and often by White men. Hate crimes rooted in Islamophobia have ranged from public shaming, verbal abuse to heinous murder, which was the case of Marwa El-Shabini. In a public space she was called a “terrorist”, “slut” and told to “go home” after asking the man in question to allow her son to sit on a park swing. Marwa reported him to the authorities and in an appeals court moments after completing her testimony, he stabbed her fifteen times. Marwa died in a packed courtroom in front of her husband and child. The German media and discussion that followed did not focus on the issues of an Islamophobic hate crime, rather, fixed its attention on the lack of courtroom security.

The Journey Beyond

Attitudes, actions and crimes rooted in Islamophobia threaten not only the lives of Muslims but also threaten the notions of liberty, freedom of thought, and democracy that underpin a just society.

We all have a moral responsibility towards a better society and that responsibility must begin with accountability. We must be accountable to ourselves – we need to challenge the biases we hold against a woman we see in a burqa or a man going to a mosque; we need to challenge the dangerous stereotypes we hold of Muslims with regards to extremism or being regressive and we must champion the rights of everyone on the same platform of equality.

This moral responsibility extends to holding the media accountable, which has juxtaposed Muslims against “the West” and thus successfully synonymising the Islamic faith with extremism. Furthermore, we must hold our politicians, public platforms and institutions accountable for their words, actions and policies. Muslims should have the freedom to exercise their democratic right to criticise regressive and dangerous policies that stigmatise them without fears for their safety or risk of being identified as a separatist.

We must do all this and more in the spirit of diversity, inclusion, and equality. But more importantly, we absolutely must strive in the spirit of shared and compassionate humanity that embraces all persons regardless of culture, class, or creed.

“And once the storm is over, you won’t remember how you made it through, how you managed to survive. You won’t even be sure, in fact, whether the storm is really over. But one thing is certain. When you come out of the storm, you won’t be the same person who walked in. That’s what this storm’s all about.” 
(Murakami; Kafka on the Shore)

Written for the Leeds & York Partnership Foundation Trust – WREN Blogs

As I try to configure appropriate words to reflect on this year gone by, I quickly realise that simply no phraseology, nomenclature or usage of any word in any way imaginable can do justice to what I, and perhaps every individual working in the Leeds & York Partnership Foundation Trust, feels. I sit here exhausted, broken and failing to make sense of the world outside and inside of my existence.

My thoughts scatter to the opening blog for the Workforce Race Equality Network (WREN) in April 2020, where I had a feeling of blunted dread and, perhaps, a premonition pertaining to the difficulties this pandemic would bring for us not only as a workforce, but also as a society. I believed that it would test our resolve, individually and collectively, but what I did not know was just how arduous or endless the test would be.

The pandemic performed precisely as it was expected to. It took the rifts of our society, where the vulnerable suffered the most in health, welfare, education and economic spheres, and it tore through to leave behind gaping empty spaces of inequality. Not only did minoritised and marginalised communities feel the direct brunt of the coronavirus associated morbidity and mortality, it also worsened issues that we were already struggling to deal with such as a dramatic rise in domestic violence, worsening poverty, furthered gaps in education, and adverse health outcomes for women and children from specific backgrounds.

The havens, sanctuaries and safe spaces that we held close to us also suffered; important festivals were cancelled, community and religious spaces closed down and we were left socially isolated from our loved ones for months. We were not able to mourn and grieve properly; we could not say goodbyes to our loved ones, we saw delayed funeral prayers and the lack of crucial spiritual final rites that gave meaning not only to those who passed on but also to those remaining behind without them. As a society we have not been able to mourn as we know how to. The pandemic took away the tactile aspects of mourning where families come together and hold each other in their arms. It took away any consolation, hope and solidarity that as humans we are so used to giving in the ways we know best during hardship.

To think that this alone was not struggle enough; the world witnessed the oppression of individuals and communities in a brazen and unapologetic manner across the globe through various mechanisms. Communities identifying with specific faiths, cultures and race felt isolated and alone under the various lens and filters of their respective oppression. So forgive me when I consider the entirety of 2020 riddled with nothing but wounds, pain and sorrow.

However, there is something else that I also muse upon and that is the ability of the tiniest glimmer of a fading candle, which is enough to light up the blackest clouds of darkness. The light that I speak of has not been an external source though. It has come from the kindness, compassion and care from the people working in this very Trust. It has come from us and for us.

Grief has a fantastic ability to convince us that we cannot get back up; it makes us question whether we can do the simplest things as before; it takes away a part of us and leaves behind a conviction etched in stone; that all is lost forever. It makes us question our role and purpose in our private lives but also in the service and care we provide for our patients and if it is indeed good enough.

As I navigated the murky waters of my own loss, people from this very Trust gathered around me and supported me in ways they knew how. Whilst they could not change my circumstances they made their position clear that they were there for me. Whether this was an email at a crucial time from Sara; David’s regular phone calls just to ensure I was ok; Wendy’s regular check-ins and WREN task-based therapy and Sharon’s ongoing infinite amount of tea and time – they all played their part in ensuring this inexperienced junior doctor had some form of clarity and support in the most unclear and isolating of times. They have all given me insight into not only the type of doctor or leader I want to be, but the type of person I want to be in these roles.

Continuing this reflection of the people in LYPFT, I have found hope and solace in the individuals who make up this Trust; the staff on grass root levels. My colleagues in CMHT OPS who have continuously endured my rookie mistakes, my work family working in the North Wing who always have kept spirits high during the most difficult of times and the trainee doctors who have regularly messaged and checked up on me.

Any reflection and gratitude is incomplete without considering WREN, its members and their contributions. WREN has become the crux of wellbeing and a safe space for anyone wanting to join and be present in any capacity they can. Despite the challenges of this year, the network members came together to celebrate diversity and inclusion on every platform. WREN, individually and collectively, has supported its members in unlearning, learning and voicing our vulnerabilities through this process. It has been a platform where we have cried together, held each other and stood in solidarity together. Each and every member has done what they know best – supporting earnestly, endlessly and abundantly without seeking a return. Whilst the pandemic has taken so much from us and will most likely continue to take, the spirit of WREN members has consolidated my belief in resilience and that we WILL get through this. It has indeed made me proud to be affiliated with the Trust and call these people my colleagues and friends.

The journey continues, however, as we move forward not only must we reflect on the lessons of this year but we must also decide upon the values that will define us as not only as individuals but also as the organisation we represent. We may be different versions of our former selves through this year, it perhaps would be abnormal if we were not, however, the constant that should remain is the continuous process of togetherness, solidarity and finding allies in our colleagues for our causes.

The message, which remains the same as it was in my first blog, has to be one of equality, inclusion and rooted in collective humanity.

Now more so than ever.

“Asian men beat up their wives and force them to cover up. Mummy says Asians are bad people.”
“Really?! Thank God I am not an Asian!”.

This is a conversation between two five year olds where the first child spreads word about dangerous Asian Muslims for the safety of the other child, who is incidentally her friend. The second child is horrified that such atrocities are taking place and feels a sudden surge of anger towards Asians for their callousness.

I was the second child.

I was so horrified about what I heard that an immediate protest was necessary. I was adamant that the authorities must find out who these Asians were and make them accountable for their actions. Admittedly, at the age of five years, the only authority I recognised was my mother’s and so to her I presented my case and sought justice. She heard what I had to say and her first (and perhaps appropriate) response was educating this simple child before her. That was the day I learned that I was an Asian.

In a single moment I went from being Abbie’s “friend” to being her “Asian Muslim friend” – all within the span of a sentence or two. In all fairness, the revelation that I was an Asian Muslim was also shocking to Abbie. It turned out ok though. Mother provided us with some curry and rice and all was well again.

Whilst I continued to meander through life and explored my identity as a Muslim, I discovered that a lot of people had a whole lot to say about a Muslim woman and what her existence should entail. The voices disproportionately belonged to the male gender – both, in and out of the Muslim community.

Being a Muslim woman is not an easy task, especially if you are “visibly” a Muslim woman i.e. wearing the hijab. During sixth form and the first semester of my first degree, I decided that I wanted to wear a headscarf. Both my parents tried to talk me out of it as they felt I might experience a backlash. The Mothership, in her desperation, even tried the “it will ruin your hair” approach (we, the Khan’s are somewhat dramatic in our approach to life).

Nevertheless, it was not long before the hijab came off. A person’s decision to wear or not to wear any item of clothing should be their prerogative. My decision to take the hijab off was not based on a spiritual reflection or my journey as a Muslim. Rather, on a winter evening whilst walking from the J.B Priestly library to my car – a white man thought it funny to pull my headscarf off. As hilarious as it may have been for him and his friends, it made me question why someone felt bold enough to walk into my personal space and rip something off that was a part of me. I picked my scarf up, got into my car and went home.

The concept of identity is perhaps one of the most burdensome things I have tried to understand in recent times. Not only are constructs of identity determined by our perceptions, associations and experiences; they are also closely embedded in historical, political and anthropological frameworks.  Identity, unfortunately, is somewhat an essential disease of the human condition. Whilst it can give the security of being part of something bigger than oneself, it also provides the basis of othering communities and nations.

On the Equality and Diversity checklist I manage to score points for gender, race, disability and religion. Whilst any struggles I may have endured as a woman of colour with a disability have been supported and my causes championed, it’s the Muslimah (a Muslim woman) who feels isolated at times. I believe my feelings are a reflection of how we perceive these attributes as a society. I have never been challenged, mocked or belittled for the other aspects of my identity. A whole community of voices, rightly so, would rise to challenge that. However that is not the case when it comes to Islamic identity. In a true dystopian sense I found myself in a society that is compared to a letterbox, burglar and stereotyped as “traditionally submissive” by public servants. This made the headlines, led to 300%+ Islamophobic hate crime in a week and forgotten about by the next.

I have not experienced any significant backlash or direct Islamophobia. However, I wonder how much of that is related to my conscious decision to not talk about my faith. I avoid talking to the Muslim community about it in case I am not the right type of a Muslim. I also avoid talking about it to the non-Muslim community in case I am not the right type of Muslim for them, either.

Islamophobia has become brazen, amplified and accepted during my lifetime. Muslims will continue to feel isolated and outcasts of society so as long as political, institutional and social spheres continue to unapologetically let Islamophobic comments and actions slide. Silence in the face of human rights violations is not mere silence. It is the validation of the discriminatory act.

I have not come across any other religious group in my personal circle who has explicitly been asked to cite their position on fundamentalism. Prior to 9/11, it would seem absolutely bizarre to me if someone asked my views on terrorism or if I was a “moderate” Muslim. It has become a pathological norm to expect people to ask this question now. This is how much society has shifted. This is the impact of Islamophobia. We accept and internalise the narrative and that is what we pass on to our children. Unfortunately, the voices rising to support victims of Islamophobia have not been diverse. A progressive society cannot pick and choose the definition of solidarity and support and apply it in varying senses. In the words of my great friend, Priyam, single issue progressive is not progressive in the truest sense of the word.

The issues associated with Islamophobia are not distinct from racism, sexism, anti-Semitism or xenophobia – they are all constructs and modalities through which minorities are discriminated against. However, my concerns, specifically to this debate, are with the intersectional aspects of Islamophobia and its widespread social acceptance.

The media narrative has successfully juxtaposed Muslims against the West. The issue with the “us versus them” culture is that it forms a basis for prejudice and discrimination in society. The statistics regarding treatment of Muslims are damning – the highest unemployment rate, the highest likelihood of being restrained in prisons, worst health outcomes, highest proportion of society living in the most deprived local authority areas etc. You can peer into any public sector and find objective evidence of discrimination against Muslims be it education, justice system, employment or welfare.

I have reached the point in this piece where I must leave you, the reader, to question and reflect on all that has been said and all that remains to be said. However, my final and most important point is that the issue of Islamophobia is not an issue of the rights of a specific religious group. It is the issue of basic human rights, which are entrenched in international law, celebrated as fundamental pillars of a just society and applicable to all people regardless of class, colour, culture or creed.

And if we are not striving towards a just society – then what are we for?

Written for and published by The Rights Collective.

The definition of caste

Caste is an identification and social stratification system acquired through birth and often sustained by endogamy. Caste, although closely interlinked, is distinct from class, race and ethnicity. It is a form of association and social capital and a form of social separation and ranking. Caste has historically restricted and penalised individuals through various exclusions in arenas of education, health, employment, politics and personal life¹.

Practically, the organising principles of caste are based on a hierarchy with those “at the top” being perceived to be the purest and able to enjoy social privilege and entitlement, whereas those “at the bottom” are perceived to be polluted, untouchable and their very existence is considered a punishment for their sins.

Historically, those “at the bottom” of the rung served society in tasks that were considered lowly and beneath society. Socially, they were prevented from walking on the same roads as those belonging to higher castes, not allowed to drink from the same water source, and not permitted to “contaminate” the eating vessels. They were even prohibited from praying to certain Gods, could not enter certain temples and had different schools, should they be fortunate enough to be able to go to school at all².

Whilst Article 15 of the Indian Constitution (1950) has outlawed caste discrimination³; there is still very much a practical and ideological practice of caste and caste discrimination that exists in India and anywhere Indians have migrated. Citing the National Crimes Record Bureau, author Arundhati Roy, in The Doctor and the Saint, scraped the surface of the tribulations faced by Dalits or Scheduled castes in India⁴. She writes,

“A crime is committed against a Dalit by a non-Dalit every sixteen minutes; every day more than four untouchable women are raped by Touchables; every week thirteen Dalits are murdered and six Dalits are kidnapped. In 2012 alone…1,547 Dalit women were raped and 651 Dalits were murdered. That’s just the rape and butchery. Not the stripping and parading naked, the forced shit-eating (literally), the seizing of land, the social boycotts, the restriction to access of drinking water”.

Not only do the discriminatory practices exist in the subcontinent – the mindset has migrated and reinforced across borders – in the places we call home, and as such we have a duty to understand, challenge and rectify something that sits deep within our communities, within our cities and towns and somewhere deep within our psyche. It must be understood so that it can be challenged and amended.

The origins of caste

The origins of the caste system can be traced to the Rigveda, a collection of ancient Sanskrit texts. The creation story describes the division of Purusha, a primordial being, into four varnas, or castes, namely, the Brahmins from the mouth, Kshatriyas from the arms, Vaisyas from the thighs and Shudras from the feet. Each had specific roles from a divine and social perspective. The Brahmins were priests ordained to recite and teach the Vedic scripts; the Kshatriyas were warriors who protected society; the Vaisyas were merchants who engaged in trade, financial and agricultural matters; and the Shudras were the labourers who served society. A fifth category, excluded from the varna system, comprises of “untouchables”, later Dalits.

Dalit is a political term, which means broken in Marathi. This term has also been used interchangeably with Scheduled Caste. It is a political umbrella term, which includes individuals from various castes who have been subjected to the practices of untouchability.

Caste-based discrimination was firmly embedded by the 2^nd Century CE with the compilation of the Law Code of Manu, an influential Hindu text citing decrees and regulations and ideas on purity and piety. The laws were caste-based and placed the severest sanctions on Shudras, whilst establishing the Brahmins as conciliators, things worldly and divine. Logistically, the enforcement of the Code varied depending on local practices and it was the British implementation of these laws, which exacerbated already existing caste discrimination, which persists today⁵.

The British Raj

The administrative, logistical and scientific flaws by the British influenced not only the colonial policies relating to structuring and politicisation of caste and state sanctioned hierarchy; they have also arguably led to sustained discrimination and enduring toxic outcomes for Dalits today.

The East India Company’s First Governor General of India, Warren Hastings, in 1772 directed its courts to pass verdicts based on the Law Code of Manu and to formalise caste law⁶. Given that the Code was in Sanskrit and not an area of remote expertise for the British, there was a heavy reliance upon the educated Brahmins to interpret, translate and accordingly advise the British. Through this, the state consolidated higher caste privileges and enshrined it within governmental legitimacy and thus tighten the “Brahminical grip” on British India’s subjects. The regressive practices of caste-based discrimination were not lost upon the British and it was recognised that the institution’s enablement of caste was a significant impediment to India’s social progress. This realisation was exploited for British gains.

The East India Company, and subsequently the British Raj, had interests centred on cost cutting, raising revenue and firming their grips on the country they ruled. Thus, there was no incentive to dismantle the caste-based system and the associated impact of caste-based discrimination. Rather, the caste-based divide offered lucrative means of control for the British.

Some stated that although “barbaric”, caste was the fabric of Indian society and thus did not warrant governmental interference unless it specifically affected the state. Some took the view that by dismantling caste in the name of human rights the repercussions would entail revolution and anarchy. The Vellore Mutiny (1801) and Sepoy Mutiny (1857) led the British to spend a significant amount of time, effort and financial input to gain a fuller understanding of the local Indian demographics in order to find allies against future uprisings as well as local aid in stamping out potential revolutions⁷. Indeed, the caste-based system proved beneficial for the British Raj not only financially, but also, diplomatically. Encouraging discord between different caste groups made a unified Indian front against the Crown an unlikely endeavour and therefore a way of assuring continued British rule.

The Partition

British departure from India came with the Partition of 1947, which saw the formation of a new nation, Pakistan. During the Partition, the eastern province of Bengal was split into a Hindu majority province (West Bengal) and a Muslim majority nation of East Pakistan, which is present-day Bangladesh.

The national and provincial borders came at a cost of one million lives and twelve million displaced peoples, arguably, the bloodiest mass migration in history. The Independence from the British was followed by a personal and state wealth, communal violence, and loss of lives. Quite aptly summarised by the prolific author Khushwant Singh⁸;

“The fact is, both sides killed. Both shot and stabbed and speared and clubbed. Both tortured. Both raped”.

The communal violence associated with the Partition is often presented as only between Hindus and Muslims. Embroiled on both sides of the partition and bearing the brunt of it to present day were the Namasudras.

The Namasudras, a Scheduled Caste, were largely situated in East Bengal. During independence, Namasudras were involved in discussions and negotiations with political stakeholders under the Dalit movement to secure equality and social justice. Their support was needed politically, and they were promised political representation for a move to the “Hindu West”; what transpired was effectively minimal political involvement, ineffective mobilisation and a geographical displacement coming at a personal cost far greater to them than others⁹. The post partition economic situation, famine induced starvation and residual communal violence merely changed the location of the difficulties Namasudras would face from the East to West. The very State, which once sought alliances with the Namasudras, eventually employed measures to evict and purge them from the West as they rallied for their rights. They encountered financial sanctions, political imprisonment, police brutality and sexual violence. Many still await political and legal recognition as Indian citizens¹⁰.

United Kingdom

Caste-based discrimination is not only a problem in a country thousands of miles away from us. Prejudice and discrimination also affect the 250,000 Dalits for whom UK is home, where there is an overall population of 4.5 million South Asians¹¹. Studies have concluded that notions of “untouchability” and its underlying ideologies not only migrated with the diaspora but they actively persist with discrimination occurring within the educational, health, professional, religious and personal spheres.

The British Government amended the Equality Act 2010 (Section 9) to make caste an aspect of race, thereby making caste discrimination effectively a form of racial discrimination. However, caste discrimination does not have legislative protective measures that explicitly prohibit it. The current framework of handling caste discrimination is via case law provides insufficient protection for the victims as the Courts may have varied interpretation of the Equality Act 2010 with reference to caste.

The half-hearted attempt at giving a legislative power to outlawing cast discrimination has led to the reluctance of victims to take the legal course of action and as such, there remains only one case, Chandhok vs Tirkey (2014)¹². Other barriers to seeking legal aid include pressures from social groups, fears of retaliation and of course the financial implications associated with litigation.

For social justice to be upheld with respect to caste discrimination in the U.K., the law must be clear, as must the path towards it, which unfortunately, is simply lacking in the British legal discourse. The importance of a robust legal framework accepted and adhered to within the community are paramount to social equality and justice. Ambedkar said,

“If the fundamental rights are opposed by the community, no Law, no Parliament and no Judiciary can guarantee them in the real sense of the word”.

The U.K. does not have adequate legislative framework at present and thus the real journey of educating and socially normalising the wider community remains a distant dream until the former is realised.

The world is not a disconnected phenomenon. We can no longer remain in our ivory towers and look down on caste discrimination as “a problem of the East”. India is a major economic power and we have business, political and personal affiliations with it. To choose the path of silence is a passive complicity and acceptance of the breaches in Dalit human rights, be it home or across international waters.

References

1. Dirks NB. Castes of mind. New Delhi: Permanent Black; 2003.
2. Rodrigues V. The essential writings of BR Ambedkar. New Delhi: Oxford University Press India; 2004.
3. The Constitution of India. India; 1950.
4. Roy A. The Doctor and the Saint: Caste, Race, and Annihilation of Caste, the Debate Between B.R. Ambedkar and M.K. Gandhi. Haymarket Press; 2017.
5. Heath B. The impact of European Colonialism on the Indian Caste System. E-International Relations; 2012.
6. Riser-Kositsky S. The political intensification of the caste system: India under the Raj. Penn History Review. 2009; 17 (1): 31 – 49.
7. Ambedkar BR. Dr Ambedkar on the British Raj. Edited by DC Ahir. New Delhi: Blumoon Books; 1997.
8. Singh K. Train to Pakistan. New Delhi: Penguin Books India; 2009.
9. Dwaipayan S. How the Dalits of Bengal Became the ‘Worst Victims’ of Partition. The Wire: History. 2009. (https://thewire.in/history/partition-dalits-bengal) (Accessed August 2020)
10. Bandyopadhyay S. Partition and the Ruptures in Dalit Identity Politics in Bengal. Asian Studies Review. 2009; 33 (4): 455 – 467.
11. International Dalit Solidarity Network. Country profile UK. (https://idsn.org/countries/uk/) (Accessed August 2020)
12. Ford M. Caste discrimination under UK law. Oxford Human Rights Hub: Equality and none discrimination. 2015. (http://ohrh.law.ox.ac.uk/caste-discrimination-under-uk-law-chandhok-v-tirkey/) (Accessed August 2020)

Written for the Workforce Race Equality Network (WREN) blog article for Leeds & York Partnership Foundation Trust.

“A just society is that society in which ascending sense of reverence and descending sense of contempt is dissolved into the creation of a compassionate society”

— B.R. Ambedkar

The South Asian Heritage Month (SAHM) was initiated this year and it runs from 18^th July to 17^th August with the purposes of commemorating and celebrating South Asian heritage and cultures within the context of their contemporary and historical relationship with the United Kingdom.

The socio-political discourse of two distinct geographical areas on a map, namely, the UK and South Asia have forced individuals, groups and entire nations to consider the issue of identity at various points in history – I certainly am no exception to this query of “Who am I?” and “Where do I belong?”. Unfortunately, just by being born and nurtured in this country has not automatically afforded me the luxury of confidently claiming to be “British”, without being challenged. Compartmentalising and categorising my existence exclusively to a British or Pakistani framework are an impossible and an unfair ask. The truth, and perhaps the essence of my identity, is somewhere in between and thus both must be acknowledged.

The celebration of my heritage does not merely start in Balochistan or Punjab, where my parents were born. Rather, it starts long before the British colonised India, where my ancestry lies. The Indian subcontinent was the epicentre of one of the oldest civilisations in the world, the Indus Valley. The region has rich tradition in the fields of language, literature, music and contributions to the earth, basic, medical and social sciences.  Similarly, my complicated relationship with my British heritage is a direct result of the colonisation of my ancestral home and its aftermath.

The British rule over India lasted over two hundred years and ended with the Partition of India and formation of East (present day Bangladesh) and West Pakistan. The Partition is one of the biggest mass migrations in world history, which left one million dead and over twelve million people displaced. The contributions, albeit non-consensual and enforced, of British India to the Crown have been great. India provided raw materials to Britain that were used to flood the world market and thus providing an astronomical amount of wealth to Britain whilst concurrently destabilising the Indian economy. Economists believe had the region not suffered this economic setback at the time of independence, the region’s economy would not be in the dire state it is today. The native manpower also provided a backbone for the British army and saw the largest contributions from India to both the world war efforts.

Following British withdrawal from its colonies and the aftermath of WW2, the UK had a severe labour shortage and thus encouraged economic migration and promised British citizenship to those from Commonwealth nations.

As my forefathers joined other immigrants to work in various British sectors, they faced racial discrimination and violence. My parents were told on many occasions to “go back to where you came from”, whilst my school contemporaries found it acceptable to scribble in my workbook “dirty paki”. The shame I felt for being brown, dressing differently and speaking languages other than English led to anxiety and a withdrawal during core schooling years. Unfortunately, these experiences are not unique to my situation. Countless young individuals unnecessarily hated and repressed a rich, beautiful and vibrant heritage during their formative years. The generation who migrated felt the brunt of the othering process, whilst another generation stands here today perhaps questioning why home does not feel like home at times? What are we? Who are we? If not here, where do we and to whom do we belong?

Prejudice and discrimination remain insidiously embedded in British society and can be found in housing, education, health access and job recruitment, retention and promotion. A recent YouGov poll reports that two thirds of Black Britons experienced racial slurs; three quarters had been asked “Where are you REALLY from?” and half believed their career development had been hindered. The Lammy, Timpson and McGregor-Smith Reviews identified and provided scrutiny of the practices that need review and reform with relation to racial disparities within the criminal justice system, school exclusion and directly relevant to us, race in the workplace.

Whilst the SAHM provides a rightful platform of celebrating the South Asian diaspora’s heritage and contribution to British Society, it must also become a platform recognising the sacrifices, losses and pain which were woven into narratives through the historical association with the British Empire. As individuals and institutions, we must strive for diversity, equality and true inclusivity in order to create not only a just workspace but a just society for the generations to come. By no means an easy path but most certainly one to celebrate.

References
I will gladly provide the original sources of factual information referred to in this blog, upon request.

 

In the loving memory of my self appointed editor, best friend, and cheerleader. Our very first conversation centred around inequalities, prejudice, and discrimination pertaining to gender and race. You continued to challenge the orthodoxy and status quo at every opportunity. Despite the darkness surrounding the limitations of the human condition…you continued to have hope in humanity. The world has lost a good human…and I have lost an entire world.
x

“The likelihood that your acts of resistance cannot stop the injustice does not exempt you from acting in what you sincerely and reflectively hold to be the best interests of your community”.
– Susan Sontag

Crises, whether they are economic, political, humanitarian, or as the current pandemic, health related – they test us. They test us as individuals, and they test us as nations. They test every fibre of our existence in our resolve to continue with a sense of normalcy in a construct where nothing remains “normal”.

The pandemic has challenged us in our professional and personal lives on a continuous basis. However, beyond the trials that we face as individuals, we face constant battles as a society. The legacies left behind, once this pandemic subsides, will be preserved by history. They shall remain a point of reference and learning for the future generations who will inevitably, at some stage, face pandemics of their own.

The suffering associated with Covid-19 is not restricted merely to economic and political fronts, rather, it has complicated the ethical and moral dilemmas associated with inequality and discrimination, specifically to this blog, race, and ethnicity.

There has been a global rise in the open racism and xenophobia targeted towards the Chinese diaspora who have been vilified and blamed for the spread of Covid-19. These incidents are not restricted to isolated individuals, however, recognised official institutions across the globe have been setting reckless and dangerous precedents through political speeches, religious rallies, and even within educational institutions.

Unfortunately, the model of blaming a specific group of people as disease vectors is not new. History is riddled with similar examples of this “othering” process. During the 14^th Century Black Death, the Jewish populations were assaulted and ostracised; the Irish Catholics were blamed for the cholera outbreak in 1858 with hospitals for immigrants being burned down; the Chinese population in San Francisco was persecuted for the outbreak of smallpox in 1878. More recent examples include a prominent Congressman writing to the CDC in 2014 advising them that children from Central America imported diseases to the US; the vilifying of black people for the 2013 Ebola outbreak as well as the continued stigma associated with HIV/AIDs.

The danger with stereotypes is how they have historically informed discriminatory practices. For example; different screening procedures depending on one’s race or ethnicity, passing bills to prevent the entry of specific nationals across borders; and, denying access to education and healthcare.

Back to present day and the current outbreak – whilst our immediate professional priorities have been maintaining the safety of our patients despite daily trials of minimal PPE, lack of testing and limited resources – there remains an urgent need to constantly challenge the inequalities that this pandemic fuels on an ethical front – and the matter of race becomes crucial in this. The message we send has to be one of equality, inclusion, and rooted in collective humanity.

 

This article was recently written for the Meer-e-Karwan series. Several months have passed since I have been able to write and certainly life has passed since I was able to write something so personal and raw. My gratitude to Niharika who has kindly edited the editor! 

Here goes. 

Body image and society – personal trials and tribulations. 

Being bullied for my weight is the earliest memory I have of school. Being told that “you’re a fat tub of lard…” is my strongest memory of an interaction with a trusted relative from my formative years. Throughout my school years I hid in classrooms and libraries so I could avoid the verbal, sometimes physical hostility, from some of my peers. I was weak for I had not known what strength was. I was not empowered for I could not find my voice. I was lost for solutions because I hid what hurt me day in and day out.

So – when a little while ago I made a Meer Monday promise of writing something about body image, I had naturally considered the trajectory of childhood obesity, associated playground bullying and the challenges of social exclusion and discrimination manifesting into low self-esteem, anxiety and depression.

However, I am painfully reminded on a regular basis that the ridicule, bullying and victimisation has not ended on the concreted playgrounds of our educational institutions. It transgresses and follows us into our adult lives, work spaces, social spaces and worst of all, the havens that we call home and family.

So it stands to reason that we talk about all of that today. However, before we proceed, I would like to offer disclaimers. This extended monologue is NOT about the scientific reasons of obesity or indeed, any short-cut solutions. It is a narrative, which focuses on the effects of negative experiences pertaining to body image and societal reactions.

I have deviated from my usual clinical style of writing, which is succinct, factual and usually drawing upon statistics. Instead, there shall be an outpour of personal experience with the intentions of giving an insider’s view of what is wrong with and what needs to be focused upon in order to nurture a society, which can move beyond its stereotypes and prejudices.

I was at a wedding over the weekend and was reprimanded on an individual’s inability for “not recognising you…you have gained so much weight, how did you let yourself go?”, as well as being the comedic interval for some “Oh, so fat you have gotten, max lol” (then said individual proceeded to do a King Kong expression). The best ones are of course the aunties with the life changing advice of “Eat salads and go to the gym”. I could applaud such astute and gifted advice.

Some of them are even quite concerned about your life moving forward, “You know, if you don’t lose weight then you shall only get married to someone like you”. What? To a progressive liberal who has been emancipated through the culmination of his life experiences leading him to accept and love humanity based on the credentials of their personality, moral values and NOT their dress size? Thank you Aunty, I shall have one of them to go right now.

Not having a friend until college years challenged my concepts of healthy friendships and relationships. The longest running cognitive defect I have carried has been the lack of self-worth and believing that I do not deserve friends, do not deserve kindness and do not deserve love because of how I look. It was not until I was in Oxford that I found the most fundamental aspect of an individual’s social growth and progress – the facilitation of accepting of oneself wholly; recognition for the value of one’s existence and most importantly NOT being apologetic about it.

How did that come to be for me? I was lucky to find a group of friends who looked beyond physical appearances. They recognised me for what I had to offer regarding my values, ideologies and most importantly, the quality of friendship. They have fiercely challenged my biases against myself and reprimanded me against the unkindness I have shown myself.

The outcome of this is a thirty-one-year-old unmarried overweight brown female who values and believes in herself and her contribution to the lives of those individuals who are linked to her (oh, and she now has a tendency of owning the dance floor once she gets the moves going – thank you, Abhilasha).

The perceptive ones amongst you will have noted the references made to certain parameters of age, race and marital status. All of these are further examples of artefacts that have no real significance except being arbitrary descriptors, which are utilised to judge and draw an irrelevant correlation to the worth of an individual’s existence. Unfortunately, these artefacts will continue to plague individuals and their self-worth unless a conscious effort is made to alter this.

So where do we begin? Firstly, challenge yourself. Do you hold discriminatory values? Do you make jest of an individual’s personal features be it weight, appearance, mannerisms etc? Do you laugh at the fat jokes, black jokes, gay jokes, sexist jokes? Stop doing it and where appropriate (hint: appropriate at ALWAYS) make an apology for your decorum.

Secondly, identify bullying behaviour. Is this happening in your child’s school or playground? Is this happening in your home? Who is it happening to? How is this affecting them? Challenge such behaviour – do it with kindness but with assertiveness.

Thirdly, educate. I firmly believe that a moral education begins long before a child enters school, in the confines of their home and personal environment. Teach them about acceptance, kindness and eradicate archaic social concepts of what a right and wrong body should look like. Show them how to empower those who are broken and vulnerable. Enable them to create spaces of fairness and justice, where bullies are challenged.

Fourthly, challenge institutions. Schools, colleges and universities are sacred intellectual spaces. Their responsibility does not stop once the examination papers have been handed in. They are a key component in shaping the environment where individuals grow, develop their sense of personality and find their social standing. Arguably it therefore becomes our duty to ensure our intellectual spaces facilitate anti-bullying and anti-harassment policies. Expect these institutions, which have a moral and legal obligation to safeguard our children, to gather information of the social practices within their grounds and inform us about the experiences of our youth. Only then we can collectively attempt to make individual experiences better and not lead people down paths of doubt, low self esteem and broken morale.

An eighteen year old woman chronically raped by her father, brother and uncles since she was nine. 

A nineteen year old girl having chronic pelvic and genital pain secondary to genital mutilation in the name of culture, tradition and honour. 

A twelve year old girl child sold and married to a forty-two year old man in her village. 

A twenty-eight year old woman physically beaten on a regularly basis by her alcoholic husband. 

A forty year old woman kidnapped and sold to her former husband at the age of sixteen. 

 

These are just examples of women and female children whom I have come into contact with through my clinical practice, outreach work and in my social life. I have found these women in the emergency rooms, in psychiatric facilities, in the genitourinary medicine & contraception clinics. I have found these women not only as a doctor in the corridors of hospitals – I have found these women in the lanes of my life.

They all have been subject to violence. Violence against women takes place in several forms – physical violence by intimate partners, sexual harassment, sexual violence, female genital mutilation, trafficking, child marriages etc.

Although there is an increased awareness of the violence suffered by women and female children, we still live in a society where these crimes are horrifically rampant. We live in a world where a third of the countries have NOT outlawed domestic violence. We live in a world where 1 in 7 girls are married in Central and West Africa before they are 15 years of age. We live in a world where 1 in 2 women were killed by their partners and/or families in 2012. We live in a world where up to a third of adolescent women describe their first sexual experience as rape/sexual abuse. We live in a world where thirty-seven countries exempt rape perpetrators from prosecution if they are married or marry the victim after the event¹.

The purpose of this article is to educate and discuss the nature of violence experienced by women, to understand the extent of the problem, and finally, what to expect from our health professionals and our governments.

The vast majority of the statistics and information is taken from the World Health Organisation and the United Nations websites, which I implore you to read. All of the factual information, which is present in this article, from the aforementioned institutions is listed at the end.

Background and definitions

Violence against women is a global public health problem and a violation of human rights. The United Nations defines violence against women as “any act of gender-based violence that results in, or is likely to result in, physical, sexual, or mental harm or suffering to women, including threats of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or in private life”^-2

A 2013 analysis conduct by WHO with the London School of Hygiene and Tropical Medicine and the South Africa Medical Research Council, used existing data from over 80 countries and found that worldwide, 1 in 3 women have experienced physical and/or sexual violence by an intimate partner or non-partner sexual violence³.

Risk factors⁴

The risk factors for women experiencing intimate partner violence include low education, exposure to mothers being abused, abuse during childhood, attitudes accepting violence, male privilege and women’s subordinate status.

Equally, men are more likely to perpetrate violence if they have low education, a history of child maltreatments, exposure to domestic violence against their mothers, alcohol dependence, unequal gender norms, attitudes accepting violence and privilege over women.

Factors associated with sexual violence perpetration include beliefs in family honour, sexual purity, ideologies of male sexual entitlement and weak legal sanctions for sexual violence.

Impacts on health, children and socioeconomics

Physical and sexual violence against women has led to physical, mental, reproductive and sexual health issues of victims. Some of these include unwanted pregnancies, sexually transmitted infections and other gynaecological problems. Specifically, in pregnancies, the risks include miscarriage, pre-term labour and the babies being at significant risks related to low birth weight.

 Women exposed to partner violence are as twice as likely to experience depression; almost twice as likely to have alcohol use disorders; 1.5 times more likely to acquire HIV, syphilis, chlamydia or gonorrhoea and 16% more likely to have a low birth weight baby. Furthermore, 42% of women who have experienced physical/sexual violence at the hands of a partner have experienced further injuries as a result and 38% of all murders of women, globally, were committed by their intimate partners^1,3.

Children who witness such violence can display behavioural and emotional disturbances as well as being at risk of being perpetrators of violence themselves. Intimate partner violence has also been linked with higher rates of infant and child morbidity and mortality³.

The social and economic costs include women being at risk of suffering isolation, not being able to work, losing wages, not participating in regular activities and being unable to care for their children.

Prevention and response⁵

There are a number of guidelines as to how health professionals can train, prepare and respond for issues in violence against women. These include:

1. Providing women centred care – professionals offering first-line support when violence is disclosed i.e. empathy, non-judgemental attitude, privacy, confidentiality and access to relevant services.
2. Identifying and caring for survivors of intimate partner violence – Professionals should ask about exposure to violence with the aim to improve diagnosis, identification and subsequent care. First line clinical care should include emergency contraception, STI and HIV with relevant follow up.
3. Mandatory reporting of intimate partner violence to the police is NOT recommended. Professionals should offer support to report the incident if the woman chooses. It is important to know the legal framework of reporting in each state/country. Usually if an incident is to be reported, the professionals should NOT carry out an intimate examination.
4. Training of healthcare providers – Adequate history taking, risk management, investigations and planning management should be done at a pre-qualification level.
5. Healthcare policy and provision – Care for women who experience violence and sexual assault should be, where possible, integrated into existing health services as opposed to a stand alone service. In the UK, this can include presenting to a General Practice, GUM services and if required, A&E.

Prevention is a powerful tool and evidence base from high-income countries has suggested that advocacy and counselling improve access to services for victims and are effective in reducing violence. In low resource countries, prevention strategies that have shown some effectivity include programs that empower women economically and socially through a combination of microfinance and skills training related to gender equality; that promote communication and relationship skills within couples and communities; transform harmful gender and social norms through education⁶.

Legislation is another key aspect, which can help achieve change. There is a need to implement policies that promote gender equality by ending discrimination against women in marriage, divorce and custody laws; ending discrimination in inheritance laws; improving women’s access to employment and developing national policies to address violence against women^5,6.

 References and further reading

1. United Nations. Declaration on the elimination of violence against women. New York : UN, 1993.
2. United Nations. Fact and figures: Ending violence against women. http://www.unwomen.org/en/what-we-do/ending-violence-against-women/facts-and-figures
3. World Health Organisation. Global and regional estimates of violence against women. Prevalence and health effects of intimate partner violence and non-partner sexual violence. http://www.who.int/reproductivehealth/publications/violence/9789241564625/en/
4. World Health Organisation. Violence against women and children: facts. http://www.who.int/news-room/fact-sheets/detail/violence-against-women
5. World Health Organisation. Primary prevention of intimate-partner violence and sexual violence: Background paper for WHO expert meeting May 2–3, 2007
6. World Health Organisation. Infographics: Violence against women infographic. http://www.who.int/reproductivehealth/publications/violence/VAW_infographic.pdf

 

Written as part of the Meer-e-Karwan series.

The purpose of this article is to discuss mental health, the issues of stigma and to signpost to some important resources and organisations.

Mental health problems are a significant contributor to the overall disease burden worldwide, with major depression being the second leading cause.

1. 1 in 5 adults experience mental illness in a given year
2. Mental health and behaviour illnesses are estimated to cause over 40 million years of disability in 20-29 year olds.
3. In Britain alone; between 2003 and 2013, 18,220 people with mental health problems committed suicide
4. I in 15 has made a suicide attempt in their life.
5. 75% of young people with a mental health treatment are NOT receiving treatment
6. The average wait for effective treatment is 10 years^1-3.

The World Health organisation definition of health is “a state of complete physical, mental and social well being and not merely the absence of disease or infirmity.” Mental health in this regard refers to our emotional, psychological and emotional well being.

There are a number of mental health problems and they are multifaceted in their aetiology. For example, they can be caused by a combination of biological factors (e.g. genes, brain chemistry), life experiences (e.g. trauma, abuse) and/or family history of mental health problems⁴.

Physical and mental health are also not two separate entities as poor physical health increases your risk of developing mental health problems and individuals with mental health problems have a worse trends in morbidity and mortality.

Mental health problems can include depression, schizophrenia, post traumatic stress, learning and eating disorders as well as substance misuse and addiction. The discussion of these is beyond the remit of this article, and as such, we shall focus on the stigmatisation of people with mental health problems.

Society and Stigma

Despite the vast numbers of people affected by mental health problems, there is a huge social stigma and discrimination that is experienced. This stigma crosses barriers of countries, cultures and various creeds. Nearly nine out of ten people with mental health problems face discrimination and statistically we know that these groups face issues with finding work, being in a steady relationship, having adequate housing and being socially included in mainstream society².

Mental health stigma can be divided into two types;

1. social stigma – prejudiced attitudes and discrimination directed to those with mental health problem
2. Self stigma – the internalisation by the mental health sufferer of their perceptions of discrimination, leading to feelings of shame and guilt⁵.

Stigma has three important aspects to it; stereotypes, prejudice and discrimination⁶.

1. Stereotypes represent collectively agreed upon notions of groups of people and often include negative beliefs about mental health issues e.g. perceptions of danger, incompetence and character weakness.
2. Prejudice is the endorsement of stereotypes and they involve a negative evaluative component, which can yield to emotional responses (e.g. anger, fear) to stigmatised groups. The power in prejudices can be seen when it turns inwards e.g. being at the centre of prejudice can lead to many persons not pursuing life opportunities for themselves.
3. Discrimination is the unfair treatment of someone based on their mental health problems.

Strategies for changing public stigma

Broadly speaking, three approaches have been proposed to deal with social stigma; protest, education and contact⁷.

1. Protest include challenging the inaccurate and hostile depictions of mental health, which can be found in media and public opinion.
2. Education is the provision of information to individuals and groups in order to maximise their understanding and lessen negative stereotypes. A number of studies have shown that educational strategies have led to improved attitudes and reduction in the likelihood of discriminating⁸.
3. Contact includes people with mental health disorders meeting those without, especially in the context of a social environment e.g. work. Research has shown that such contact events have led to decreased endorsement of psychiatric stigma.

What can YOU do?

Educate yourself!

Mental health issues are extremely common and unfortunately, so is the prejudice and discrimination against the people who are affected. The first step is always to educate yourself, and then to educate others. Knowledge is a powerful tool, which can not only help break down stigma, but also to help empower groups of people to come forward and seek the help they need, without the fear of perceptions. Below are some useful resources, which provide with statistics, have educational material and signpost to relevant groups for professionals, patients and the general public.

 

Resources

Time to change.

https://www.time-to-change.org.uk/

Social movement working to raise awareness of and ending stigma associated with mental health.

Mind

https://www.mind.org.uk/

Mental health charity in England, which is working to procvide information and advice to those with mental health problems.

Mental Health Foundation

http://www.mentalhealth.org.uk/

Improving lives of those with mental health problems and/or learning difficulties.

The centre for mental health

http://www.centreformentalhealth.org.uk/

Organisation working to improve quality of life for those with mental health problems. A wealth of information and support links.

Depression Alliance

http://www.depressionalliance.org/

Information and support to those affected by depression.

Relate

http://www.relate.org.uk/

Offering advice, relationship counselling, workshops and meditation.

Anxiety UK

https://www.anxietyuk.org.uk/

Charity supporting those living with anxiety disorders including information provision, support and 1:1 therapy.

 

References

1. Time to change. About mental health. https://www.time-to-change.org.uk/about-mental-health
2. Mental Health Foundation. Mental health statistics: https://www.mentalhealth.org.uk/statistics/mental-health-statistics-most-common-mental-health-problems.
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