January 2000, Volume 50, Issue 1

Original Article

Human Cost of Political Violence

A. R. Jamali  ( Department of Orthopaedic Surgery, Jinnah Postgraduate Medical Centre, Karachi. )
Seemin Ghulamullah  ( Department of Orthopaedic Surgery, Jinnah Postgraduate Medical Centre, Karachi. )
Irfan Qureshi  ( Department of Orthopaedic Surgery, Jinnah Postgraduate Medical Centre, Karachi. )
Ghulam Mehboob  ( Department of Orthopaedic Surgery, Jinnah Postgraduate Medical Centre, Karachi. )


Objective: To evaluate the cost of political violence in terms of human life and its influence on social, psychological and financial aspects of communtiy.
Design: Retrospective study conducted from 1987 to 1989.
Setting: Department of Accident and Emergency, Jinnah Postgraduate Medical Centre, Karachi.
Sample size: Nine hundred and fifty four victims including two hundred and fifty seven dead.
Results: The mean age of the victims was 27.29±9.46 years with a male to female ratio of 33:1. All ethnic groups suffered to some extent. No case of violence on religious differences was reported during this period. Firearms were frequently used. Most of the deaths (92.2%) occurred due to firearm injuries. Landhi, Korangi, Malir and Shah Faisal Colony were the worst affected areas. There was however no significant difference between them. The projected loss of life for the dead was approximately 3.15 million days. The same was difficult to assess for the injured because of multifactorial reasons. Six thousand four hundred and ninety two close family members suffered from Psychological and Physical Trauma. The number of distant members affected psychologically was estimated to be 0.566 million. Schooling of approximately five thousand four hundred thirty seven children of the victims suffered.
Conclusion: Political violence has significant short and long term effects on the society in terms of physical and psychological trauma, financial losses, poor schooling and health, biased pattern of dii Ed development, migration of families and further division of society into identifiable communities which may prolong the conflict (JPMA 50:25, 2000).


Violence based upon political, ethnic, religious or cultural grounds has universal existance but the worst affected areas are Asia, Africa and Latin America. Pakistan is no exception. Multiple factors operate simultaneously to create an environment conducive to existence and perpetuation of violence. The cost that we are paying as a nation for this, is enormous in terms of life, finances, social and moral values and degradation and division of the society. It is now engulfing wider sections of our society. The purpose of this paper is to look into the cost of such violence in terms of human sufferings.

Subjects and Methods

This retrospective study was conducted at the Jinnah Postgraduate Medical Centre, Karachi from 1987 to 1989. All the victims who were dead or injured at the time of arrival to the accident and emergency department as a result of political violence directly or indirectly were included in this study. The term political violence was defined as ‘a physical violence such as torture, burning, rape, fire arm injuries etc committed due to differences based upon political, ethnic or religious grounds”. (Modified from Barnes I definition of the hate violence) The victim was defined as “a person who was intentionally made the target of political violence or a person who was injured or died during course of such events unintentionally,though he was not a specific target”.
The data was based upon the medicolegal records of the Jinnah Postgraduate Medical Centre maintained at that time under the prevailing condiUons. However there were many lacuna in the records as on many occasions, the sex, age and affliation of the patient was not recorded because the victims were unknown and brought to the hospital by the police or the workers of Edhi’s welfare organisation either dead or unconscious and unable to communicate. We have included them as such. The age of the victims was recorded on the basis of the statements of the relatives or on the judgement of recording officer thus was approximate in nature. The number of dead is also under estimated, since those dying later in the hospital were not included in this study.
The data was collected for sex, age, political, ethnic or religious affiliation, type of the injuries and the area where the incident occurred. Data was analysed for the projected loss of working life and the number of persons affected physically and psychologically as a result of such violence.


A total of 954 victims were seen during 3 years of whom 257 were dead on arrival and 697 injured. Most of the victims were males and they out numbered the female victims by a massive ratio of 33:1 (Table 1).

Majority of cases belonged to the younger age group. The mean age for dead was 28.7 ± 9.9 and for injured 27.9 ± 9.9 years (Table 2).

All ethnic groups suffered during violence but Sindhi / Balochi speaking (24%) and Urdu speaking (16.2%) were on the higher side. The number of Urdu speaking cases is under estimated because majority of unknown victims belonged to this group but were not recorded. Only workers of the Peoples Party (Political party) were target of this type of violence. Many of the victims were hit by random firing. No case of violence based on religious difference was reported during this period (Table 3).

Firearm injuries (75.5%) out numbered other injuries and caused most of the deaths (92.2%). Many cases had multiple injuries. Number of cases of physical torture (drilling of body, burning, electric shocks) significantly increased during the last year of study (Table 4).

Similarily an increasing trend towards the use of firearms and target killing was observed with passage of time. AK 47 rifles and T.T pistols were usually used during these incidents of violence. Landhi, Korangi, Shah Faisal colony and Malir (Previously district east Karachi) were worst affected and more than 70 % of the victims were brought from these areas. There was no significant difference between these four areas (Table 5).

Based upon the average life expectancy of 62.5 years for male2,3, the loss of working life was estimated to be approximately 3.15 million days for dead. It was difficult to assess the same for the injured persons because of multifactorial reasons such as the morbidity period, extent of disability, absentia from duties, loss of job or business, displacement and psychological stress.
Based upon the fact that 6.7 persons were living per housing unit4, approximately 6492 close members of family would have suffered from the physical and phychological trauma. This includes 5437 children. This is an under estimation because in our society not only immediate family psychological trauma.
Based upon the rough estimate that each victim had one spouse, two parents, five brothers/sisters, their five spouses, ten uncles/aunties, thirty first cousins and their thirty spouses, twelve mother/father inlaws and thirty six  members but other relatives and friends also suffer from brother/sister in laws with their thirty six spouses along with four hundred twenty six children in family, the number of persons affected psychologically rises to approximately 0.566 million. This is also a partial statement, since the psychological effects produced by the media would have affected the whole nation.
The effects on the schooling of children was tremendous. Not only that the children of the victims (Approximately 5437) suffered, there were children of the perpetrators of crime and of the innocent citizens on the recieving end due to prolonged tension, curfews, closing of schools and migration of people. The result was that children of these areas were not only lagging behind in time frame but were also receiving substandard education.


Political violence (modified from Barnes I) invariably occurs in each and every part of the world since the prejudice on which it is based exists in most parts of the world. It is far more important in terms of age and sex5-7 as most of the victims are young males in their prime working life. Few of them die and remaining become temporarily or permanently disabled7. The worst offender weapon8 is firearm. The same is observed in our series. Not only that but in the following years, it has turned from bad to worst as most of the victims of recent violence are subjected to in­human torture and then killed mercilessly. In some cases the dead bodies have been desecreted which only points to the sickness of mind.
The effects of such trauma are many fold and tremendous on the victims, their families and children as well as on the children of the perpetrators of crime and innocent observers as a result of covictimization1,8-20.
The effects on the victims include loss of life5-7, physical injury,7 disability7 loss of job21, migration’ and disturbance of social life11,16,22. Most show psychological derangements such as anger, fear, sadness, depression, aggression, and tendency for drug abuse1,11,16 Two types of responses14 were seen in such victims following interactions between their internal and external environment (a) Positive Solidarity, bravery and increased appreciation (b) Negative harrassing, thuggery and Scapegoating. The group with positive response showed the will to survive in bleak and hopeless present. The same was observed in the victims with a purpose of life”. However those with purposeless life and depression were prone to become violent”. Few of the victims purchased weapons to defend themselves’.
The effects on children of victims included disturbed education, poor health and psychological disturbances also called as the post traumatic stress disorders12 (PTSD). This will not only affect the rest of the chib’s life, but will influence the development of coming generations17. The important amongst them are child’s view of the world, his social map and moral development12. The effects of adult led processing of young child’s experience to his/her psychological coping and moral development in the presence of contradictions operating in the environment may provide him short term support in the shape of fanatical ideology and extremism12. However this will prolong the communal conflict and increase his vulnerability.
Since community violence affects many facets of the child development19, these children tend to aquire deviant pattern10 of processing social information which could lead to aggressive behaviour, severe emotional stress15 and in some cases depression14. This has been observed in surviving children of the holocast17 who continue to live with perplexing questions and memories. Their normal development was mutilated and had an extremely difficult task of reconstructing the terrible past into a sensible present. This problem does not end here as the development of the children of perpetrators is also abnormal and adult led processing may take it to extreme. However they develop emotinal conflicts, sense of guilt and low morality when they understand the moral implications of what there parents did8,23.
Effects of the covictimization are not universally accepted as Shakoor20 did not find such effects in his study. Nadir18 et al on the contrary did observe guilt feeling and post traumatic stress reactions due to covictimization. This covictimization not only occurs by the direct observation but also by the coverage of media9.
We did not cover this aspect in our study, however there are ample reasons to believe that such effects are taking place as can be observed by low standard of education, degradation of moral values, intolerability, increasing violence and drug abuse.
Additional problems of violence are search for safety1,24 and financial loss21. Cornish et al24 while observing the perceptions of violence in Northern Ireland found that the ingroup locations were considered safe and less violent as compared to outgroup locations. Similarly Barnes’ estimated that one third population of the affected area either migrated or purchased guns for safety. Other factors for migration from such areas are poor schooling, closure or disruption of the financial institutions and disruption of the normal social life which may influence even those who may not have suffered violence directly. Such migration and concentration in few localities along with financial loss could lead to multiple health problems such as malnutrition, infections due to communicable diseases as health and social services are over stretched.
No data has been published on this subject in Pakistan nor reliable figures are available, however there are clear signs that such things are happening and areas have been divided according to ethnic, political or religious dominance.
Financial cost of such violence is tremendous. Muller et al21 calculated that physical violence in USA in 1987 cost ten billion dollars on health, twenty three billion dollars in productivity and one hundred forty five billion dollars in reduced quality of life. The average cost per death was 2.4 million dollars and per assault fifteen thousand dollars. Ryan7 estimated eighty one million dollars as the cost of treatment of one hundred and seven victims of the violence.
Actual data about the financial implications of such violence in Pakistan is not available but considering the number of people dead or injured, persistant closure of business centres, educational, and financial institutions, factories, cost of migration, devaluation of property and loss to property, it should go into billions of dollars.
However the worst are the long term effects of such violence in the absence of preventive measures due to its inherent ability of self perpetuation on positive feed back mechanism . This will continue to cariy on to the coming generations. Normal development in the children of victims is mutilated17 and they grow with sense of hatred, danger and chaos. They have severe character pathology19 and deviant pattern10 of processing of social information. They continue to survive with perplexing questions and memories and are prone to fall prey to the short term support provided by the fanatical ideologies under the influence of adult led processing of psychological and moral development. The adaptation of such an ideology could become extremely dangerous in the years to come. Any chance of return to sensible normal development17 is further hampered by the migration of families to the ingroup neighbourhood for safety and prejuidiced media coverage of the events as it blocks the interactions between communities. Unfortunately we are observing these long term effects of the violence and probably our coming generations will continue to observe them.
Another long term impact of such a violence due to variety of reasons25-28 is division of population into identifiable groups on different basis26 and creating a community psychology26,29-31 which is the key concept of separatism. These communities to a large extent loose the ability to judge the events properly or accept the right or wrong in true perspective because deviant pattern’0 of thinking, perception and processing of events and decision making.


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