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In late November, the body of fourth year medical student Nosheen Kazmi was discovered in her dorm in Larkana city. Word spread quickly among her schoolmates, who were shocked and frightened. She was the third student to allegedly die by suicide at their university in the last two years.

“We were gathered outside the dorm gates and when we turned our cell phones on, we saw news reports of the case,” Kazmi’s friend and classmate Imran Ali told VICE World News. “Nosheen’s body was still in her room. No investigation had even been conducted at this point and yet the [university’s] spokesperson had given an official statement of suicide.”

As pictures of the tragedy were leaked online, students at Shaheed Mohtarma Benazir Bhutto Medical University in Pakistan’s southern province Sindh were plunged into collective déjà vu.

The public university, named after Pakistan’s first female prime minister, Benazir Bhutto, and located near the birthplace of the Bhutto political dynasty, had made national headlines recently for several incidents of its students allegedly dying by suicide in their dorm rooms. 

In Sept. 2019, Nimrita Chandani, a dentistry student in her final year at the university, was found dead in her room. In May 2021, senior medicine student Tariq Shahani was also found dead in the university’s campus in Sukkur city. Kazmi, Chandani, and Shahani all reportedly died of asphyxiation. 

The incidents have touched a raw nerve in Pakistan. Shocked by the astounding frequency of the deaths, students, activists and journalists have led demonstrations across the country demanding a fair and transparent investigation into the deaths. 

University students from Hyderabad city hold a demonstration after the alleged suicide of medical student Nosheen Kazmi. Photo: Progressive Students Federation Sindh

In two of the cases, the university’s own hospital led the post-mortem investigations, whose findings of suicide were questioned by Kazmi’s and Chandani’s families.

“Nosheen Kazmi is a victim – a victim of something the medical college administration fights to hide. We strongly reject the post-mortem report, and a neutral and independent forensic expert team is required for a transparent investigation,” Doctors Wake Up Movement spokesperson Uzair Chauhdry told VICE World News. 

Some believe the university is hiding the true cause of the deaths due to a conflicting post-mortem report in Chandani’s case which stated that she had been strangled and sexually assaulted before her death. Despite this, a judicial probe still ruled that there was no foul play involved.

Meanwhile, others who think it could indeed have been suicides have blamed the medical university’s lack of mental health support and suicide prevention initiatives on campus.

“Unfortunately, the [university] administration has not taken any measures for promoting mental health. There have been no fliers, no emails, no mental health discussion groups. I am sorry to say that not a single person from the administration has tried to reach out to the students on this subject,” Aqsa, a medical student who requested their name be changed for fear of facing repercussions from the university, told VICE World News in December.

On January 1, the university held a mental health seminar in which its vice chancellor Anilla Attaur Rehman said that the administration will be forming a council to provide psychological help to students, faculty and employees. She also said that they will be holding similar seminars in the future. 

However, students don’t buy the administration’s promises. 

“The event was scheduled during our final examinations and so was barely even attended by students. There were mostly professors and staff members present at the event. If it was truly meant for students why weren’t we informed? Why wasn’t it held at a time when we would have actually been able to attend? Nothing has happened since,” said Ali. 

The university’s vice chancellor declined VICE World News’ requests for comment stating that the government had not allowed her to talk to the media. Other members of the university’s administration could not be reached by VICE World News for comment, despite multiple attempts. 

In Pakistan, which has one of the poorest mental health indicators in the world, mental health remains a highly neglected and stigmatised subject. Massive treatment gaps are rampant, with less than 500 qualified psychiatrists in a population of 220 million. More than 90 percent of people with common mental disorders remain untreated. Higher educational institutes are no different, where glaring omissions in mental health treatment continue, with little hope of improvement. 

Regardless of whether the deaths were by suicide or murder, one thing is clear: students are dealing with trauma and mental health issues, resources for which are strongly lacking not just in this university, but in most others in Pakistan. Whether provided years before or more recently, mental health support may have helped prevent suicides, or help students cope with the deaths of their classmates. Students want answers, and support while they grapple with complex realities.

University students hold a protest against the Shaheed Mohtarma Benazir Bhutto Medical University administration after Nosheen Kazmi’s death in Larkana city.

“Counselling services are very scarce in educational institutions in Pakistan, except for a few top-tier private institutions. In the majority of institutions there are no counselling centres for students to screen them for mental health issues and to refer them to professionals for help,” Abdul Wahab Yousafzai, professor of psychiatry at Shifa International Hospital Islamabad, told VICE World News. 

“Due to this, there is a lack of destigmatisation of mental health issues, and students continue to suffer in silence. Students who are very sick and demonstrate suicidal ideation need immediate care and attention, but this does not occur and we miss that opportunity to get them the help that they need.” 

Research has indicated that medical students suffer from higher rates of stress, anxiety and depression than their peers. Social problems, suicidal ideation and burnout have also been documented as concurrent conditions among medical students. 

Gruelling course curriculums, cut-throat competition, extensive workloads, sleep deprivation and exposure to patient suffering and deaths are some of the reported contributing factors in causing mental distress among aspiring doctors. 

With the onset of COVID-19, the mental health of medical students in Pakistan has reportedly deteriorated further. A study conducted in collaboration with the World Psychiatric Association, which surveyed 1100 medical students in five universities in Punjab, found that 48.6 percent of students had anxiety, while 48.1 percent were reported to be experiencing depression. One in five students thought they would be better off dead, while 8 percent admitted to often thinking about suicide in the past two weeks. 

According to suicide prevention expert Aneela Maqsood, the strenuous educational pressures within Pakistan’s highly competitive medical universities require additional mental health support interventions. 

“There must be a continuous mental health support system in such highly specialised institutes,” said Maqsood. 

Mental health experts say that suicide prevention protocols in educational institutes exhibiting patterns of suicide among students need urgent crisis management mechanisms. “If you see repeated cases in an environment, it’s really important to dig out why this is happening. A crisis assessment must be there, and there must be a thorough analysis of possible risk factors, of something that is unique to the area, or something that is happening as part of the psychosocial means in a given context,” said Maqsood. 

Kazmi’s schoolmates say that their university had not adopted any suicide prevention protocols even after the three successive cases. 

“No mental health support was extended to any student. We have never been furnished with any mental health support at campus in general. Talking about mental health here is like banging one’s head against a wall. Local cultural attitudes regarding mental health treatment are very disappointing,” medical student Quratulain Ismail told VICE World News.

“The only thing the college administration did after Nimrita Chandani’s death was to increase security measures, especially for female students. They installed CCTV cameras in the hostels and increased the number of guards at the hostel gates,” said Aqsa. “These are good measures and in no way am I against them, but I don’t see how they are going to help a student who is going through a difficult time.”

Without any help from the university, students have decided to just look out for one another’s mental health on their own, Aqsa said. “They are encouraging each other to talk about things that they are going through.”

For Kazmi’s friend Ali and other students at the university, their daily struggles compounded by the unanswered questions around their schoolmates’ deaths have left them with a sense that they are no longer safe inside campus.

“If these cases are suicides like they claim, why have they not implemented any suicide prevention protocols even now?” Ali said. “Yesterday, it was Nimrita and Tariq. Today, it’s Nosheen. We don’t know who will be next.” 

If you or someone you know is considering suicide, help is available. Call 1-800-273-8255 to speak with someone now or text START to 741741 to message with the Crisis Text Line.

Follow Rimal Farrukh on Twitter.