Friday, July 23, 2004
DASHED HOPES LEAVE SCARS ON IRAQI HEARTS AND MINDS
Society was traumatized even before the war but now many people are at their wits' end. Mark Turner looks at mental health in Baghdad
A bustle of activitybreaks the calm outside DrWisam Ibrahim's office in Baghdad's Ibn Rushd psychiatric hospital, as two men rush in a woman clad in black, sprawled in a wheelchair.
Hannah, 28, stares vacantly as her brother and her husband appeal to the doctor for help. Her condition began two days earlier, they say, after her other brother, a former member of the Ba'ath party, was shot while parking his car. He died soon after he was brought home.
Occasionally, Hannah raises her hand, thumb pressed to fingertips, to her puckered lips.
"She kissed her brother like that," they explain. "She grasped his hand."
Dr Ibrahim diagnoses her as having "conversion disorder" - a form of hysterical neurosis. "We advised them she needs to be hospitalised. She should not attend the mourning day, or she will recall the events," he says. "But our people consider psychiatric disorders a stigma. They (the family) refused. They just want medication."
After decades of conflict, repression and sanctions, Iraq was a traumatised society before the US-led coalition invaded. But after a year of dashed hopes and mounting insecurity, Hannah is one of a growing number of Iraqis who have reached their wits' end.
"This is one of the consequences of the war," says Dr Ibrahim. Unlike the previous regime, which placed mental health low on the priority list, the new government is paying attention to the psychiatric sector. But drugs are scarce and the system is sorely stretched, with little provision for home visits, monitoring of patients or counselling.
Dr Ala'adin Alwan, the Iraqi health minister and former head of the World Health Organisation in Jordan, says overcoming medicine shortages is the health sector's biggest challenge. Making matters worse, few new doctors are being trained.
The mental health sector is no exception, suffering from under-staffing and a lack of medicine. "We don't have any system, and there is a shortage of psychiatrists," says Dr Ali Rasheed, who also works in Ibn Rushd. "There is no observation (of patients) to see whether they take their treatment or not. Families have no support. We have a shortage of time and space."
The consequences of inadequate care can be extreme. Dr Fatih Faiz, who works with the forensic psychology department in the Al Rashad psychiatric hospital, claims that unscrupulous organisations recruit the depressed and people with personality disorders to conduct suicide bombing attacks.
Dr Ibrahim recalls one depressed patient who recently told him: "If you don't treat me I will explode myself against the Americans." He explains: "He felt helpless - that there was no point being alive."
Dr Faiz agrees: "They can't stand another 10 years of promises. When depres sion becomes severe, it can push you to the idea of suicide. And (certain) groups of people can lead you to a way to end the suffering."
Dr Rasheed and Dr Ibrahim spend the morning prescribing drugs for a constant flow of outpatients. The current insecurity has exacerbated the conditions of some, he says, while others are more recent victims.
"This patient is psychotic," explains Dr Rasheed of one of his chronic patients. "Because he has no job, he is relapsing." Another patient comes in with depression: "She had become well on treatment, but now there is a shortage of drugs." The doctors are allowed to prescribe only three days' medication at a time, he says. A lack of monitoring has also contributed to an increase in drug abuse.
In a private practice in Baghdad, Dr Mohammed al-Ubaidi says he has seen a dramatic increase in patients suffering from paranoia since the war started. He is prescribing between 50 and 60 per cent more Prozac, at higher doses.
"People quarrel outside to get their visit: they want to get back home as soon as possible. They are afraid," he says. As if to emphasise his point, gunshots ring out in the street outside as he speaks - witnesses say armed robbers have attacked a local supermarket. "Nearly 100 per cent of Iraqis suffer from anxiety. Everyone had great hopes," he says.
Back in Ibn Rushd, a former Iraqi military officer and prisoner of war in Iran says his psychosis is getting worse. "The situation is so difficult and complex," he explains. "How can I live in peace?"
Dr Ibrahim looks at him sadly as he departs. "He sacrificed his life, but no one cares," he says. "He suffers from a severe sense of frustration. He was a general and now he's a street cleaner."