Nabila’s drawings are like any other nine-year-old’s. A house rests besides a winding path, a winding path on which wander two stick figures. Tall trees, rising against the back drop of majestic hills. Clouds sprinkled over a clear sky.

Nabila’s drawings are like any other nine-year-old’s. With one disturbing exception.

Hovering over the house, amidst the clouds, above the people, are two drone aircraft.

Perhaps this is the scene she saw moments before the drone strike, a mental photograph captured with crayons.

Nabila lives in the village of Tapi, in the northwest of Pakistan, an area perpetually under drones. With the strokes of her crayons, she lets her reality spill out onto paper. (Image credit for drawing: Reprieve).

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Drones started appearing in Nabila’s drawings after she saw her Dadi (grandmother) blown to pieces by a hellfire missile in 2012, a strike that left her, her 12-year-old brother Zubair and 7 other children injured.

Beyond the harrowing tragedy of death and injury, living under drones leaves deep psychological wounds.

An Arbitrary Threat

A night spent in agony.

“I spent my Eid in the hospital,” Zubair tells me about the day he was injured in the drone strike, running his finger down the faded shrapnel scar above his knee. The physical scar may have faded but the mental scars are etched much deeper.

Nabila lifts up her sleeve to show me where she got hurt. She then grabs my camera and bounces off the walls, snapping photos. I’m in a New York hotel room with Nabila, Zubair and their father Rafiq. Pizza boxes litter the room; the TV drones on, indistinct and irrelevant. The day before, a crisp October 29th, 2013, they had testified at a Congressional hearing, recounting the events of last year. The family is exhausted from the countless, constant interviews with the media; from the cab rides zigzagging through New York City (“New York is like Peshawar, while DC is like Islamabad,” Zubair remarks while we’re on our way to yet another interview); from reciting the same story over and over again. The family is featured in filmmaker Robert Greenwald's documentary Unmanned: America's Drone Wars. Greenwald and the fantastic teams at Brave New Foundation and Reprieve toiled tirelessly for months to bring them in front of American lawmakers.

October 24th, 2012, the day Nabila’s Dadi Mamina Bibi was killed, was much like the day in her drawings. A blue canopy stretching out as far as the eye could see. Drones lingering overhead. Nabila and her Zubair working with Dadi in the field next to their home. The drones hovered lower than usual that day, casting a particularly loud thrum over the village. Zubair had grown much too used to their incessant buzzing. He ignored them; no reason to be worried. After all, Zubair isn’t a terrorist. He was more preoccupied with the Muslim holiday of Eid which was the next day–a "magical time filled with joy." October 24th, 2012, the day Nabila’s Dadi Mamina Bibi was killed, was much like the day in her drawings. A blue canopy stretching out as far as the eye could see. Drones lingering overhead. Nabila and her Zubair working with Dadi in the field next to their home. The drones hovered lower than usual that day, casting a particularly loud thrum over the village. Zubair had grown much too used to their incessant buzzing. He ignored them; no reason to be worried. After all, Zubair isn’t a terrorist. He was more preoccupied with the Muslim holiday of Eid which was the next day–a "magical time filled with joy."

Although English was his favorite class, he was eager to get out of school to get home. After wolfing down his roti(bread), he appeared before God for the afternoon prayer. Dadi had promised him that celebrations would start as soon as he finished his chores.

As Zubair cut grass, he saw two beams of light hit Dadi. A scream pierced through the shroud of smoke that had descended onto the field, blotting out the sun. His thigh burned.

Although, it happened over a year ago, Zubair and Nabila cannot assume that the threat is over since they have not been told why their home was targeted in the first place. In his congressional testimony their father Rafiq asked, "Congressman Grayson, as a teacher, my job is to educate. But how do I teach something like this? How do I explain what I myself do not understand? How can I in good faith reassure the children that the drone will not come back and kill them, too, if I do not understand why it killed my mother?"

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Discussions around drones often revolve around discrepancies in the number of those killed, often glossing over the experiences of those still living.

Mamina Bibi’s grandchildren live in perpetual fear of the drones that lurk overhead.

“They whiz around in a circle, sometimes two, sometimes four,” Rafiq says, making a circling gesture with his right index figure.

Dr. Mian Iftikhar, who has been practicing in the northwest of Pakistan for 26 years, told me that he has received many cases of “anxiety disorder –generalized anxiety disorder when the anxiety symptoms are persistent, and phobic anxiety disorders— [when the patient has a] phobia of going to public places, schools, institutions, markets, which attract suicide bombings, terrorism or drone strikes.”

“Anxiety disorder is always associated with threat or risk,” he explains.

The arbitrary nature of drone strikes is exactly what makes them so scary. Like terrorism, drones generate disproportionate fear because they can happen anytime. “I’m afraid to go outside. I don’t even see my friends anymore,” Nabila says.

Living Under Drones, a report outlining the terrorizing effects of Obama's drone assaults, is the result of nine months of intensive research. The report is "based on over 130 detailed interviews with victims and witnesses of drone activity, their family members, current and former Pakistani government officials, representatives from five major Pakistani political parties, subject matter experts, lawyers, medical professionals, development and humanitarian workers, members of civil society, academics, and journalists.”

Before he joined the faculty at Stanford Law School, Stephen Sonnenberg, the co-author of the Living Under Drones report, had worked in many conflict zones. “In most war zones, civilians will be able to tell you how to protect yourself, ‘if you don’t go out here, if you don’t do this.’ There are strategies for survival,” he tells me. Sonnenberg’s experiences in the north west of Pakistan were different.

“One of the things that struck me personally in talking to drone victims was that they didn’t have any survival strategies. They didn’t know how to behave themselves. [It was remarkable] the way people perceived that this all-seeing eye could strike you from nowhere.”

People don’t have “survival strategies” because the drone program is shrouded under a cloak of secrecy. The US government does not disclose how they classify a militant or a civilian, or what constitutes behaviour warranting a drone strike. A report in the New York Times from May, 2012 reveals that the American government counts all military-age males in a strike zone as “militants.” Hence the Pentagon’s low count of collateral deaths

In four years Zubair can be counted as a militant.

Furthermore, the Obama administration executes "signature strikes," based on a “pattern of life” analysis in which suspicious behaviour is sufficient to warrant an attack. What exactly constitutes suspicious behaviour is not entirely clear.

Previously, drone strikes have crashed weddings, schools, funerals, rescuers, and Jirga gatherings (town hall meetings).

“While the number of drone strikes have drastically reduced since they first started, the policy hasn’t become any clearer,” Sonnenberg says. This is especially true for the civilians in remote, tribal areas who have even more limited access to information than the rest of us do.

January 23rd marked the 5th anniversary of Obama's war on drones. “The program is not over. It’s changing, and the changes are not in a way that is transparent,” says Sonnenberg.

Goodbye Blue Sky

Zubair and his Dadi used to love bright, blue skies, which often sprawl lazily over Tapi. They also present the ideal conditions for drones to operate in.

“I no longer love blue skies,” Zubair says.

“This is a classic symptoms of PTSD,” says Vivian Dent, a psychologist who practices in San Francisco. “There's the feeling of constant danger–the trauma lingering into the present, the active avoidance of anything that would expose him to trauma triggers [like the blue sky].”

“This is how conditioning works. You begin to associate a stimulus (in this case the blue sky) with an event (drone surveillance or strike),” Dr. Iftikhar explains.

Beautiful, blue skies had once promised a day of play.

“I used to play outside all the time. There was hardly ever a time I would be indoors. Now I’m afraid.”

Zubair, who is a skilled cricket batsman, hasn’t picked up a bat in weeks.

The zhunng zhunng buzz of the drones has become a part of the soundtrack in Tapi. Incessant. Unceasing.

The buzz of drones lull Nabila and Zubair to sleep every night.

Prolonged Bereavement

Mamina’s Bibi’s loss has wreaked great sadness and trauma on not only Nabila’s family, but the village at large.

Mamina Bibi was the “string that held the pearls together” Rafiq told Congress.

“The house feels empty without her,” Zubair sighs. “We all used to gather around her in the evening when she told us stories. Now stories are all that remain.”

Mamina Bibi’s husband, Wreshman Jan, a retired headmaster, is heart-broken and suffers from depression. Inseparable, Jan and Mamina Bibi never spent more than an hour apart. Rafiq has not seen him smile since her death.

Dr. Iftikhar explains this prolonged bereavement. “Whenever someone dies there is grief, there are rituals, a funeral. The relatives come to terms, psychologically accept the death,” said Iftikhar. In an unnatural death, when parts of the body are torn away– an arm in one place, the head in another place–the intensity of the bereavement is great, bordering on psychosis. It’s prolonged. Normally bereavement is for 3 to 6 months, but this kind of prolonged bereavement could be one or 2 years, or in some cases even longer.”

“My Dadi was a loving person. She helped many women have babies,” Nabila says, looking up from a notepad where she is drawing a portrait of me, writing out my name in the English alphabet: J-A- N-I. “I was her favourite. She would take me everywhere. My cousins would get jealous.” She giggles.

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“There was nobody like her. The villagers told us ‘you’re not the only one who lost your Dadi, we all did,” Zubair adds.

Just One Piece of the Puzzle in a Broken Mental Health System

“We were told that when patients came to a hospital doctors could tell within 30 seconds it was a victim of a drone strike because of the way they behaved,” says Sonnenberg.

The northwest of Pakistan is plagued by a plethora of problems—the spillover from the bordering Afghan war, the presence of militants, and operations by the Pakistani army. CIA drone strikes happen within this context, causing further disruption of daily life. Mass displacement, migration, chronic unemployment and poverty are all causing mental suffering on an unprecedented scale in this part of the world.

“Drones are only one component of the whole phenomenon,” Dr. Mian Iftikhar says.

They may not even be the biggest component.

“Drone hits now and then, but Talib (short for Taliban) are on the ground every day, so is the Pakistani army,” says Saifullah Mahsud, Executive Director of the Fata Research Center in Islamabad.

This makes it difficult to attribute causation of psychological problems to purely drones. While in the case of Nabila and her family, the causation is clear, when talking about the region in general, the causes blur into each other.

Although no statistics have been recorded, Dr. Iftikhar says that there has been about a 3 to 4 times increase in the cases of mental illness since 2008.

Sonnenberg confirms this by saying, “We [his team] talked to psychologists who told us that people who are losing their mind is unbelievably high.”

There are a handful of psychologists in the tribal parts of Pakistan to deal with the rise in mental illness. A 2009 report by the World Health Organization estimates a total of 342 psychiatrists.

That’s 342 psychiatrists for a population of 170 million. This means there is one psychiatrist for every 526, 315 people. Most of these psychiatrists are in urban centers.

“Many people resort to drugs like bromazepam and alprazolam, which reduce anxiety transiently but lead to addiction, if continued for a long time. Over time people build a tolerance so that they need to increase the dose to have the same effect,” says Dr. Iftikhar.

In Pakistan, these drugs can be easily obtained over the counter.

We’re looking at a broken mental health system. In a place where there is a huge stigma associated with psychological issues, and where only 2.5% of the GDP is allocated to health care, it seems unlikely that this system will be fixed anytime soon.

Disrupted Education

Rafiq had spent the morning of the strike in school teaching his usual class of around 30 children. A primary school teacher, he comes from a family of educators. All of his brothers work in schools. His father is a retired headmaster with a school named after him.

Incredibly passionate about education, he is concerned that his students are afraid to go to school.

“When the drones come close, you can see the missiles, you can hear them getting louder. My classrooms are empty on those days. The parents say to the kids ‘Go to school, Master Sahib (teacher) is calling you.’ The children say “We are scared. If he couldn’t protect his own kids, how can he protect us…” Rafiq’s voice cracks.

“Education is a child’s right, and it disturbs me to see that my students are afraid of attending school,” Rafiq tells me.

Getting educated in the tribal areas of Pakistanis is already tough. Drones make it tougher.

School attendance and access here has been greatly affected by militancy, terrorism, and sectarianism. Most recently there was a suicide bomb attempt on a school in the Hangu District of Pakistan this month, thwarted by a brave Pakistani student who was killed in the process. In June of 2013, a bomb killed 14 people at a Shiite school. In 2012, Pakistani education activist Malala Yousafzai was shot by the Taliban. In November 2013, there was a drone strike on a madrasah (seminary), which the US alleged was serving as a refuge for terrorists.

Drone strikes on schools are rare, but try telling that to the kids who look out and see drones overhead, and for whom the memory of the strike is still too fresh.

Rafiq got into the education business because he wanted to remedy what he saw as the descent of Pakistani society into militancy.

“Education can solve all problems, I got into this field to fight illiteracy. Drones are not the answer to anything,” Rafiq adds. Since the strike last year, his community has been shaken.

Apart from inciting fear, drones have also resulted in a loss of motivation.

Zubair talked to me at length about how he doesn’t see any point in school anymore.

PTSD is characterized by “the dulling of interest and activity in normal events. In a post-traumatic state, the whole body/mind becomes attuned to immediate issues of survival; longer-term projects that require flexible attention rather than the focus on danger–like school and studying–become impossible,” Dr. Dent explained.

Dr. Iftikhar tells me that there are two sources of motivation. One is an inner source–pushing force. The other is a pulling force–external incentives, opportunities and the environment.

“When kids see the destruction, there [is an] extinction of the pulling forces,” he explains.

While his children may be pessimistic about the future, Rafiq has big plans for them. “I want them to complete their education and be respected ambassadors, making Pakistan proud and representing the country abroad.” He glances lovingly at his children: Zubair with his NYC cap casually throw on backwards, face bathed in the glow of an iPhone; Nabila with her crayons in a corner. Sensing that she is being watched, she looks up at us, and sticks her tongue out. It’s covered in chocolate.