RENÉE BYER rbyer@sacbee.com
Afghan refugee Faisal Razmal, whose therapist says he suffers from post-traumatic stress disorder, talks on his cellphone to a fellow Afghan who also suffers from PTSD. In the front seat is Khyber Hussain Khil, 29, who came to Sacramento to support Razmal when he feared he was suicidal. In the back is Pasoon Khan, 24, who says he also has PTSD after being shot twice in his arm and sprayed with shrapnel during the war.

Afghan refugees in Sacramento fight PTSD

December 30, 2016 6:00 AM

They stood in a circle in the leaf-strewn parking lot of an Arden Arcade park on a November day, heads down, a knot of four friends talking about their trauma and frustration. Then they went for a walk and talked some more. When they got cold, they climbed into a car and sat.

Several Afghans who hold Special Immigrant Visas have moved from Texas and Virginia to help their friend Faisal Razmal, second from left. Here, they get together at Bohemian Park in Arden Arcade on Nov. 30.

These men – mostly still in their 20s – share a special bond. They are all refugees from Afghanistan, and they served together as interpreters for U.S. forces during the war. They came to Sacramento for one reason: Faisal Razmal. He was their friend and colleague in Afghanistan, and when they heard he was threatening to kill himself, they moved from as far as Texas and Virginia to lift his spirits. Six had arrived by late December, and another would come soon.

They met regularly throughout the fall at Bohemian Park. They barbecued lamb, sat at a picnic table and took walks. But mostly they talked. Razmal was not the only one of them who was having mental health issues, but his situation was particularly acute.

After trapping a rat in the family’s apartment, Faisal Razmal attends to his two children, Bib Maryam, 2 1/2, left, and Malek Mohammad Omar Razmal.

“The Faisal I knew in Afghanistan and the Faisal I see here are two different people,” said Maiwand, 29, a friend of nine years who declined to give his full name because he still works with Coalition Special Forces. “He was a grown-up puppy – a happy, cheerful guy always there to help people, to cover another guy’s shift if somebody was sick.”

Now, Maiwand said, “He’s kind of sluggish, off-topic. He can’t concentrate.

“He’s totally lost. … He has two little kids and a pregnant wife. We have to prevent him from doing something stupid.”

Razmal, 28, was shot in the face in front of his apartment on Edison Avenue in August 2015 by an assailant wielding a flare gun. A neighborhood teenager and alleged member of the Trigga Mob gang was charged and is awaiting trial.

Razmal said he feels like he has lost a piece of his soul, not just the sight in one eye. His struggles – along with those of other Special Immigrant Visa holders – were chronicled last year in The Sacramento Bee special report “No Safe Place.”

Sacramento has emerged as a leading destination for Afghan refugees who were awarded Special Immigrant Visas because of their service to coalition forces in the war. More than 2,000 such visa holders and their family members have settled here since October 2010, with others arriving daily. These former translators, engineers and doctors are often dismayed to discover that their credentials mean nothing here, and they must start over in bug-infested, low-rent apartments with minimum-wage jobs.

On Aug. 2, one year after Faisal Razmal was shot in the left eye with a flare gun, he said he feels frustrated that the teenager accused of attacking him in the parking lot of Skyview Villa Apartments has not been tried.

In the months since his story appeared, Razmal has not rebounded. His mental state has deteriorated, and therapists who have worked with him say that, despite his lack of an official diagnosis, he suffers from post-traumatic stress disorder, a common affliction among refugees and soldiers who come from war zones. He finds himself unable to work even as his family responsibilities are growing with the imminent arrival of a third child.

Many other Afghans in Sacramento say they are struggling with anxiety and depression that have developed or been greatly exacerbated by what has happened to them here – in what was supposed to be a safe place. They say they feel helpless and abandoned, lacking decent jobs, housing, or an understanding of U.S. culture. Mental health professionals have a name for the variant of PTSD that afflicts them: Ulysses syndrome, after the Greek hero who roamed the Mediterranean for decades before finding his way home.

Top: Afghan refugee Faisal Razmal, right, talks to therapist Homeyra Ghaffari about the paperwork he needs to qualify for disability payments. Below: Shukriya Karimi, 36, wipes away tears during a therapy session with Ghaffari as she talks about her sons, whom she had to leave behind in Afghanistan.

“People hear about America and think it is a dreamland and everything is law and order and they are going to be absolutely safe, and when they enter they are in shock as they try to find their way around,” said Homeyra Ghaffari, an Iranian marriage and family therapist in Sacramento who speaks the same Dari language as the Afghan refugees. Along with her regular caseload, she now counsels about 30 Afghans seeking help with mental health and domestic violence issues.

“They feel isolated, don’t have any clear direction,” she said. “Their dream shatters right away.”

Razmal said he feels like he’s in limbo. His left eye still aches and occasionally bleeds. Before he was shot, he worked as a security guard at a shopping center. Since then, he has tried working as a taxi driver, gas station attendant, security guard and dishwasher. But his limited vision and PTSD have compromised his ability to keep a job, said licensed clinical social worker Jason Swain, who has counseled Razmal 18 times since the assault. Swain was referred to Razmal by the Sacramento County District Attorney’s Victim Witness Assistance Program.

Razmal is waiting for the criminal trial of Renardo Dejour Williams, now 17, the teenager charged as an adult with shooting him in the parking lot of Skyview Villa apartments, a complex of beige stucco buildings on Edison Avenue that is occupied almost entirely by Afghan refugees. The trial has been postponed several times and is now scheduled for mid-January.

Until the criminal case is concluded, Razmal said, the lawyers he has contacted won’t go forward with the civil suit he wants to file against his landlord at Skyview Villa, which he says had inadequate security. Signs on a security gate at Skyview Villa promise 24-hour armed patrols, but the gate is always open, and there are no regular patrols in evidence.

“I feel like I’m drowning here,” Razmal said. “I’m not mentally fixed.”

‘Out of control’

About a mile away from where Razmal lives, another Afghan refugee featured in The Bee’s special report is also struggling – unable to overcome the trauma that has visited her family in Sacramento. Malalai Rafi’s husband, the father of her four children, was killed just 20 days after they arrived in the United States.

Mustafa Rafi, 35, was an engineer who built garrisons and power plants for the U.S. in Afghanistan. He was hit by a distracted driver while riding his bicycle on Edison Avenue in July 2015 with their son Omar, now 9. The boy was also hit. His skull was crushed, and he suffered severe brain damage.

Malalai Rafi embraces two of her four children, Omar, 9, left, and Saleha, 12. Her husband, Mustafa Rafi, was killed and Omar suffered a brain injury when they were hit by a car while riding their bicycles along Edison Avenue.

Rafi formed a shield over her face with her fingers one recent day when another pile of letters she couldn’t read arrived at the family apartment. She pulled out a stack of rent, utility and medical bills, letters from schools, enrollment forms for her four kids.

Rafi is illiterate and she still has not learned to drive. She has missed important doctors’ appointments for Omar, who spent four months in UC Davis Medical Center after the accident.

Omar’s head injury left him hyperactive, with little impulse control. On one recent day, he ran in and out of the family’s second-floor apartment to the balcony. He snatched glasses and pens from guests, then took a pair of steak knives from the kitchen and rubbed them menacingly together.

Omar Rafi, 9, holds one crumpled paper airplane in his hand as he tries to keep his brother Omran, 8, from tossing another one in their Sacramento apartment.

“All I want is to get my younger brother here,” Rafi said over and over in Dari. “He can speak and reads English. He can drive them to and from school and appointments. They will listen to him.”

Her brother, Zakir Noori, 25, is an economics student in his last year at the University of Kabul. His application for a tourist visa to the United States has been denied twice. For now, the brother talks to his sister and his nephews and nieces on Skype, offering counsel and urging the children to do well in school.

In one recent conversation, Rafi asked why Noori hadn’t told immigration officials about her plight. “The lawyer said it was not a good idea because that will lower my chances of getting a visa,” Noori replied. Rafi insisted that he do so, and he said he would next time he applied.

Maryam Rafi, 13, steadies an iPad as her uncle Zakir Noori explains on the screen from Afghanistan that his second request for a visa to come to the U.S. has been denied.

Like Razmal, Rafi is receiving counseling from Ghaffari. The therapist meets the family once a week, and leaves feeling exhausted by their mounting problems.

“Malalai has constant headaches, constant stomachaches,” Ghaffari said. “She doesn’t have any transportation. She has to cook, to clean. She has to shop and keep appointments. Omar is a handful. … It’s a really scary situation. I really don’t think therapy is going to do any good for this kid; he’s totally out of control.”

UC Davis Medical Center did not return calls from The Bee asking to speak with Omar’s medical team. The members of the team showered him with presents for his ninth birthday, which he spent in the hospital.

Malalai Rafi comforts her daughter Saleha, 12, at their family apartment in Sacramento on Dec. 1, 2016. Saleha was struck by a car along Edison Avenue, outside Arden Arcade Fundamental Middle School, on Oct. 28.

Rafi’s daughters, Maryam, 13, and Saleha, 12, also have been getting counseling from Ghaffari. Saleha was hit by a car in October on Edison Avenue outside Arcade Fundamental Middle School. She wasn’t badly hurt, but the accident conjured up memories of her father and brother being mowed down on the same street. She often crawls into her mother’s bed in tears.

Maryam has had her own troubles. She came home one day from school with a bloody lip and told her mother that another student had punched her and said her dad was a terrorist, and that her mother carried bombs in her hijab. Rafi went to school and talked to the principal, who said the school would handle the situation. The other student hasn’t been back since.

Despite their struggles, Rafi’s family has received more help than most. A GoFundMe campaign after The Bee’s first story on the death of her husband and Omar’s life-threatening brain damage raised more than $85,000, most of which has been put in a college trust fund.

FNU who?

Bureaucracy – and not knowing how to navigate it – has exacerbated the disorientation felt by Razmal, Rafi and many other newly arrived Afghans, mental health experts said.

Razmal, for instance, needs an official diagnosis of PTSD to keep his welfare, food stamps and the money he has been receiving from the California Victim Compensation Program to cover his lost wages as a security guard.

But finding someone to evaluate him hasn’t been easy. Ghaffari is neither a medical doctor nor a licensed clinical psychologist, so she can’t do it.

Faisal Razmal sits below self-help plaques in therapist Homeyra Ghaffari’s office on Nov. 29, 2016, in Sacramento.

Razmal said he visited a primary care doctor at the Elica Health Center clinic for a referral. He was initially told they couldn’t find him in the system at all. Razmal, like thousands of other Afghan refugees, entered the U.S. with the same first name: FNU, which means First Name Unknown, because U.S. officials substituted their first names for their last names on their Special Immigrant Visas, and left the last names off altogether.

So whenever he contacts his doctor, or his welfare case worker or DMV or law enforcement, they can’t find Faisal Razmal. The clinic finally found his file, but told him he couldn’t see his doctor until January.

Razmal’s fate and his ability to support his family remain uncertain. The state Department of Rehabilitation said a decision on his application for disability payments may take a year, social worker Swain said.

“I feel lost,” Faisal Razmal says as he waits for his friends to arrive at Bohemian Park in Arden Arcade on Nov. 30.

“He’s been bouncing from agency to agency for four months trying to secure some financial means for his family. … It’s crazy. I don’t know how any agency can conclude he no longer has PTSD,” said Swain.

“He certainly has PTSD from the attack, exacerbated by the fact he hasn’t been vindicated and the shooter hasn’t been punished, which prolongs his mental suffering,” Swain said.

Although he’s convinced Razmal is suffering from PTSD, Swain said he can’t write the official PTSD letter Razmal needs either, because he isn’t a licensed clinical psychologist or psychiatrist.

Said Aimal, 37, one of Faisal’s friends who recently moved here, said the U.S. bureaucracy and the fact that his educational credentials don’t count here have been far more damaging than the violence he witnessed working for a decade with the U.S. Army in Kandahar.

“I’ve seen everything in my life,” he said. “I’ve collected the remains of human bodies blown up, 5 or 6 pounds, we couldn’t find the rest. I arrived in Sacramento three months ago with my family to help Faisal. But every day I die here. You can do nothing for yourself. I was able to run a meeting for 600 guys in Afghanistan and now I can’t do anything for my 10-year-old son.”

When he tried to have his son immunized for school, Aimal said he sat in the doctor’s office for four hours, only to be sent away because his Medi-Cal hadn’t been activated.

Faisal Razmal, center, walks to alleviate stress from PTSD with other Afghan special visa holders at Bohemian Park on Nov. 30, 2016, in Sacramento. Alongside him are Khyber Hussain Khil, 29, left, and Pasoon Khan, 24, right.

He now makes $11 an hour as a security guard in Vacaville, 60 miles from his Sacramento apartment. He has stopped taking the anti-depressants prescribed for him in Virginia because he doesn’t think he can work and take them at the same time.

Pasoon Khan, 24, another one of Razmal’s friends, recently moved from Texas. He said he was shot seven times in Afghanistan but said he did not have PTSD when he left his country. “Our stress comes from resettlement here, the panic we feel, not being accepted by the community,” said Khan. He now works as an Uber driver.

Razmal came to the United States with high hopes. He carried a phone encased in the American flag. Now he is disillusioned. President-elect Donald Trump’s campaign promise to bar Muslims from entering the United States put another dent in his morale.

“If they want me to go, I’ll go back now,” he said. “Here, we’re fighting ghosts.”

‘Not in the system’

Dr. Patrick Marius Koga, a UC Davis Medical Center psychiatrist who has worked with refugees for a decade, said Razmal and many other new arrivals from Afghanistan may be suffering from Ulysses syndrome, a type of PTSD that afflicts a healthy person living in adverse circumstances with little help or guidance.

“There is no help for these people,” Koga said. “They are under the radar. They are not in the system.”

Koga says this type of PTSD often manifests itself about two years after Special Immigrant Visa holders and their families arrive. “We want people who have entered the U.S. to be evaluated at the county refugee clinic, kept on the books and followed up after three, six, eight and 12 months to see if they have clinical PTSD, but we don’t have this policy in place yet,” he said.

Bib Maryam, 2 1/2, holds her hands over her father’s eyes as she plays with him inside their Sacramento apartment on July 27, 2016.

As Sacramento prepares for an influx of 3,000 refugees from Syria, Afghanistan and parts of Africa expected to arrive in the coming months, UC Davis is advocating a more systematic screening of refugees for PTSD symptoms, said Dr. Caroline Giroux, medical director of Adult Psychiatric Support Services at UC Davis.

Giroux said U.S. veterans generally get good care for PTSD at VA hospitals. But Afghan SIV holders don’t qualify for U.S. veterans’ benefits. The State Department’s list of refugee resettlement services does not include mental health.

“Just migration is a trauma, leaving family behind, not knowing what’s happening to them,” Giroux said. “We need to build these communities, support them and destigmatize mental illness.”

Giroux said medication alone is not enough to treat PTSD, which she said affects about 14 percent of U.S. veterans. Symptoms include depression, panic attacks, substance abuse and self-isolation from a world victims perceive as unsafe.

“It takes a relationship with a professional to repair the damage and create a safe, supportive environment for healing,” she said.

Razmal and some of the other Afghan refugees in Sacramento have received help from a new nonprofit named RIHLA (Refugee Integration & Health Azimuth). The group is headed by Dr. Malikah Popal, an Afghan immigrant who came to the United States many years ago and is still familiarizing herself with the needs of current refugees. RIHLA has assumed the responsibilities of an earlier nonprofit named VIRTIS, which was headed by Afghan refugee Dr. Fahim Pirzada. He has since gone to work for the state Department of Refugee Health.

The $20,000 in community donations that poured into VIRTIS after The Bee series has passed to RIHLA. The group gave Razmal $2,000 to help cover his rent and expenses while he pursues his disability claim and looks for a job. Popal also referred him to Ghaffari, the therapist.

Razmal, who survived roadside bombs and firefights during the war, said he was never evaluated for PTSD in Afghanistan or the United States.

Ghaffari said she thinks he was already afflicted with PTSD from his experiences in Afghanistan, and was “re-traumatized” by his shooting here. She said Rafi and her children are also suffering, though they never saw combat themselves.

“Their PTSD is all about their life in America,” Ghaffari said. “She was here for a couple of days and then runs into the bodies of her husband and son lying on the street.”

Renée C. Byer contributed to this story.

Stephen Magagnini: 916-321-1072, @SteveMagagnini