Wounds new and old threaten a fresh start for Afghan veterans in US

Few nights passed during Hasib Satary’s first months in the United States when his sleep wasn’t disrupted by nightmares.

He often envisioned himself in a cage surrounded by sneering Taliban fighters, clubs in hand. When they approached him, he’d jolt awake, teeth clenched, suppressed screams quivering through his chest.

Satary’s mortal fear of capture never became a reality during his nearly two decades of service for the American mission in Afghanistan, first as a combat interpreter and then as a security coordinator for the U.S. Embassy in Kabul.

He, his three young sons, and his wife, then eight months pregnant, managed to slip out of the Afghan capital on an American military plane on Aug. 17, 2021, two days after the Taliban seized the city.

Despite escaping to the U.S., along with roughly 80,000 other Afghans that summer, Satary has found the wounds of the war difficult to leave behind.

For many Afghan veterans like him, the stresses of refugee life continue to suppress and exacerbate the traumas of combat two years after arriving stateside. Thousands with expiring immigration statuses are stuck in legal limbo. Many live paycheck to paycheck, if they can hold down a job.

Deep cultural stigmas surrounding psychological struggles and inadequate treatment options allow mental wounds to fester. Untreated, experts warn, they could carry over generations and derail the future of a community striving to break free from its past.

Satary himself has found a level of personal and professional stability that many evacuees would envy. Yet his story, in many ways, epitomizes the slow, precarious journey to recovery endured by many of his compatriots.

Satary began working as an interpreter for the Department of Defense in June 2003, two years after the U.S. military ousted the Taliban from power. He was born without a birth certificate, but he estimates he was around 17 at the time.

His family needed cash, and his English skills set him apart in an otherwise bleak job market.

“I had my camouflage uniform. I was thinking I was so cool,” he recalled. “I was thinking everything is like Hollywood movies.”

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About a year later he was in Kandahar, unzipping the body bags of Afghan soldiers killed in an IED blast. He knew most of the dead — they’d traveled from Kabul together — so his commander tasked him with identifying the bodies.

He unsheathed the first corpse, the face a jumble of bone and cartilage, mutilated beyond recognition.

“I cannot do it,” Satary recalled telling his commander.

“They are our friends,” the officer replied.

So, the teenager went body by body, pointing out features that connected name to flesh.

“This was the worst feeling I ever had,” he said. “I’d never touched a body, and I didn’t know how hard the body can be after someone dies.”

After naming the last corpse, he left the morgue and vomited. He didn’t sleep for days.

A 2018 European Union survey found that 85% of Afghans witnessed or experienced at least one traumatic event in their lifetimes. The average Afghan saw or suffered an average of four. As a result, experts estimate, at least one in every two Afghans suffers from psychological distress.

But this abundance of struggles is met with a scarcity of services. Before the Taliban ascended to power, the Afghan government spent only $0.26 per person annually on mental health services — well below the ~$4.00 standard deemed appropriate for low income countries by the World Health Organization.

Fewer than 10% of Afghans accessed the paltry services that were available, in large part because of the stigma mental illnesses carry, according to Human Rights Watch, a non-profit.

Over time, through some fusion of willpower and circumstance, Satary hardened, insulating himself from the routine horrors of the war. The crackle of gunshots, the deafening blasts, the dust and the blood, the spikes in adrenaline, the impatient lulls in between — violence became habitual and familiar.

“Dying was very simple,” he said. “A blast or a bullet will have you, you will be gone. No problem.”

There were moments, however, that pried open this shell, forcing him to reckon with how the war had changed him.

One August morning in 2009, Satary weaved through the clogged arteries of central Kabul en route to the U.S. embassy.

Soon after arriving, as guards finished inspecting his vehicle, he heard a faint bang. A burst of energy whooshed by, bending branches like storm winds. His ears rang and felt like they’d burst.

Satary threw open the car door and ran for a nearby bunker. Sirens and shrieks soon filled the silence. First responders raced by and he joined them.

He’d scrambled fewer than 50 yards before the corpse-strewn street reared into view. The car bomb had shredded the tree-lined boulevard outside NATO headquarters, now spattered with leaves, flesh, and twisted metal.

Without pause he started picking up bloodied bodies — mostly kids, he remembered — and carrying them into ambulances.

With the dead collected and the debris cleared, he returned to the embassy and rushed for the showers. Thirty minutes later he showered again — and then again, and again.

Satary couldn’t sleep for the next few nights, he recalls. He suffered terrible headaches. Visions of the children — their squeals, gashed skin and pretzeled limbs — haunted him.

Witnessing his American colleagues process the same horrors put his own psychological struggles into starker relief. A few years after the August attack, an embassy colleague was reassigned stateside because doctors and family worried about the toll the war had taken on his mind.

“I looked at the mirror and I said, ‘If [he] is going through that, I’m definitely worse than him,’” he remembered.

Still, he worried his American supervisors would deem him unfit for service if they learned of his torments. Seeking help was also burdened by shame, a sense of unbecoming weakness that came with being an Afghan man — a fighter, a father, an only son — venting about his feelings and bad dreams.

So, he continued.

Satary, now 38, cuts a graceful figure. Tall and slender, with well-coifed hair reminiscent of the Hollywood actors he once emulated as a young soldier, he projects gentleness and endears himself to others with little effort, often punctuating his sentences with a smile.

His nightmares began to subside last year, but slammed doors and other sudden loud noises still trigger a survival instinct when he’s awake.

For a time, Satary experienced a visceral intolerance for crying. Sometimes he’d leave the room to escape his kids’ blubbering. On other occasions, he yelled at them.

“For the past 14-15 years, I was dealing with high pressure, sensitive situations,” he said. “That’s probably where I put all of my patience. I don’t have much left.”

His elderly parents and his three sisters, meanwhile, remain stuck in Kabul.

Days before he fled, aware he might have to leave them behind, Satary installed a router in his parents’ home and taught his mother how to accept incoming FaceTime calls on an iPad. He’s called every day since.

“I talk to them for, like, half an hour, giving them hope that they can still see me, that I will be able to see them one day.”

When the family was together, Satary was their primary caregiver. He’d take his ailing father to appointments, change his diapers and bathe him. Now, with 7,400 miles and a vengeful regime separating them, care takes the form of a few longing “I love yous” through a lagging screen.

Supporting the family he has within reach was long a burden of its own. His wife gave birth to their fourth son a few weeks after they landed in the U.S., on Sept. 11. She suffered through postpartum depression for months.

Life’s more mundane complications piled on. Satary went months without a car. He didn’t receive work authorization until March 2022, half a year after his arrival. He kept his family fed through donations and food stamps.

“For the first nine months, I didn’t go for a medical checkup because I was afraid that they would come and tell me, you have some kind of disease,” he said. “I didn’t want to have another thing to be worried about.”

It was his responsibility to shepherd his family through the transition, to provide reassurance and stability when the world spared them so little.

“We are in the best place in the world. We have nothing to be worried about,” he’d encourage them.

“I was trying to do that to myself, thinking ‘I am fine, nothing is wrong with me.’”

A State Department colleague connected Satary with Sarah Cady a week after he landed at Dulles International Airport. The longtime social worker had worked in refugee advocacy on and off since 2003 before helping resettle the first planeloads of Afghan evacuees.

Cady, now head of the Virginia-based resettlement support agency REACT DC, has worked with thousands of Afghans since August 2021. Mental health symptoms like Satary’s, she said, are alarmingly common.

“Every refugee group comes with trauma,” she said. “The rates of undiagnosed post-traumatic stress disorder are much higher in [the Afghan] population than many of the previous [refugee] populations because of the chaotic nature of the evacuation.”

Reliable data on the scope and severity of mental health struggles in the Afghan community are hard to come by.

A survey of 1,815 evacuees conducted this spring by the Department of Health and Human Services found that more than half of respondents experienced mental health challenges. Three in four respondents said they have yet to receive professional help.

More than a dozen resettlement advocates and clinicians interviewed by Military Times spoke to the gravity of the problem.

Many evacuees had to leave behind close family, exacerbating the pain of being forced to abandon home. The agony of separating from loved ones is particularly acute for veterans and contractors, who fear their past affiliation with the U.S. government makes their relatives targets of Taliban vengeance.

“I’m physically here, but mentally I’m thinking about my family back home,” a former interpreter turned resettlement advocate — who wished to remain anonymous to protect their family — told Military Times. “I’m ready for any phone call, like, ‘Hey, your brother is no longer alive. We killed your father.’”

Yet many evacuees are too consumed by day-to-day pressures to lament.

Financial insecurity among Afghan refugees is chronic and widespread. Almost 20% of resettled Afghans surveyed by Health and Human Services this year are unemployed. Around 50% of respondents reported needing housing assistance.

Legal concerns also loom. Most of the nearly 80,000 Afghans airlifted to the U.S. in the late summer and early fall of 2021 were granted “humanitarian parole,” a tenuous, temporary license to reside in the country. Parolee status, which allows Afghans to apply for employment authorization and other government benefits, expires after two years for most evacuees.

Extending parole can be a tedious and convoluted process. Thousands who have managed to file their paperwork have yet to hear back. Losing parole can mean losing work — or, at worst, deportation. Onerous documentation requirements and months-long backlogs have stymied the hopes of those trying to secure more stable forms of residence, such as asylum or special immigrant visas. (Satary, once a parolee, now has a green card.)

“Sometimes daily problems or issues will lead to anxiety or depression that probably will increase other problems,” said Yousuf Jabarkhil, a project manager at the Afghan Medical Professionals Association of America. “They relate to each other.”

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Pathways to adequate treatment for newly arrived Afghans, meanwhile, remain riddled with structural and cultural obstacles, experts say.

Many difficulties are symptomatic of broader problems plaguing the American mental health ecosystem. Parolees and special visa holders qualify for Medicaid, which can cover mental health treatment. Still, counselors and therapists are in high demand and short supply.

An even smaller sliver of qualified therapists understands Afghan cultural sensitivities. Fewer still speak Dari, Pashto, or another Afghan tongue.

Experts doubt many Afghans would seek out treatment if quality care were readily available.

“Whenever you talk about mental health, it means [you] are totally crazy,” another former Afghan interpreter, also anonymized to protect his family, said of the stigma.

High numbers of evacuees struggle to even conceptualize psychological health as being worthy of treatment.

“More than providing these services, there is a bigger need of educating the community on the importance of mental health,” said Naheed Bahram, the U.S. operations director for Women for Afghan Women, a community organization.

A loose network of government agencies and resettlement groups, conscious of these gaps, is attempting to assemble and advertise a patchwork of affordable and accessible care options.

Jabarkhil’s organization received a grant from the Office of Refugee Resettlement in January to pilot its own mental health service. The program’s eight case workers, fluent in Dari and Pashto, share 250 patients between them, running therapy sessions of their own or connecting clients with other providers and translating sessions when needed.

The following month, the Office of Refugee Resettlement began doling out grants for “Services to Afghan Survivors Impacted by Combat,” a medley of mental health resources tailored to “Afghans who experienced combat-related trauma.”

In August, Lutheran Social Services National Capital Area, or LSSNCA, one of the country’s most active resettlement agencies, debuted a mental health program — dubbed a “wellness program” to destigmatize seeking treatment. Its two new clinicians expect to work with around 20-30 clients each.

This incremental progress is meaningful yet insufficient, advocates say. Thousands, not hundreds, need care. Time and improved circumstances can have their own healing properties, but proper treatment has few substitutes.

“We know that the mental health piece, unless it is addressed, can actually be [an] obstacle to long term refugee integration,” Mamadou Sy, LSSNCA’s chief operating officer, said. “It can delay employment; it can lead people to losing employment; or not being able to secure housing or maintain a roof over their head.”

“That August tore me down. That August marked a failure, a failure that I was not expecting,” Satary said.

The café's piano jazz playlist offered a melodramatic soundtrack for his ruminations. He twisted a coffee cup in one hand, the other rested on his legs.

He bowed his head and gazed at the table.

“I remember those last very last seconds when I was leaving my house, and my mom was kissing [the] feet of my sons. My dad—”

His free hand clasped his face. A few tears streamed through his fingers as he stifled sobs.

A few months ago, he was on the cusp of booking a flight to Kabul. The thought of his parents living out their final years alone, searing on a regular day, had become unbearable.

“I wanted to go show myself to my parents and tell them, like, I’m not out of this world,” he explained. “It will give them a hope.”

He’d tuned out the self-evident dangers of certain arrest — probable death — until he received word that the Taliban detained his nephew and demanded information about his whereabouts. He shelved the plans.

He had much to lose. His young family had found peace after seemingly interminable war. They’d bought their first home this summer. His wife is fulfilling lifelong dreams, learning to drive and practicing English. His sons made friends and are doing well in school.

Satary himself had begun to find his way. He bought a car and plays pick-up soccer on weekends. He settled into a gratifying job at LSSNCA helping Afghan peers navigate the seismic adjustments he’d endured.

And yet, he says, the itch for justice, for redemption, for some realization of himself and the open, democratic Afghanistan he gave everything to uphold, feels irresistible.

“I have friends in the U.S. Army and Afghanistan army who lost their lives. I had my colleagues in the embassy who lost their lives fighting against the Taliban,” he said. “All those people, their lives matter to me if it doesn’t matter to politicians.”

Asked if he’d go back and fight should that need arise, his response was instantaneous and unwavering.

“Yes.”