ishtartv.com - irinnews.org
By
Annie Slemrod, ABU GHRAIB/DEBAGA CAMP, 16 January 2017
Iraq
already had shortages of psychiatrists and psychologists before the rise of
so-called Islamic State. Now, as hundreds of thousands of civilians emerge from
years of IS rule, the impact of those shortfalls is becoming painfully
clear.
Many
of those needing help are children, like Emir Ibrahim. The 14-year-old was
lined up against a wall, gunshots scattered around his head. And this was just
the beginning of his punishment.
The
teenager, who had been accused of attempting to escape his northern hometown of
Hawija, recalled what happened after he was brought before an IS judge. He
“had a metal pole and started beating me with it... my back was covered in
blood. Then, they put me in prison,” he said.
Released
thanks to a payoff from his father, Ibrahim and his family fled to Debaga Camp
in Iraqi Kurdistan, a northern swathe of Iraq run semi-autonomously by the
Kurdish Regional Government (KRG).
Even
when they were safely set up in the camp, Ibrahim was still afraid to go
outside. In the end, the boy’s mother, Aya, sought out mental health support.
“Everyone
has problems like this,” Aya told IRIN. “I went because my neighbour said they
helped cure her son, so I went to ask for help.”
Overwhelming
needs
Almost
150,000 civilians have already fled Mosul as the effort to oust IS from its
largest Iraqi stronghold intensifies. With as many as a million people still
inside amid an increasingly bitter siege, more families like the Ibrahims will
likely seek professional help in coming months.
Elektra
Noutsou, until recently mental health activity manager for Médecins Sans
Frontières Switzerland in Baghdad, told IRIN that despite plenty of
warzone experience as a psychologist, she was shocked by both the level of need
and the forthrightness of patients in Iraq.
Noutsou
described patients knocking on the window of her car in Tikrit, where many
people arrived from areas near Mosul. She assumed they were seeking a general
physician for some kind of physical injury or illness. “They said: ‘No I just
want to talk to you… and also my neighbour would like to see you too.’
“At
first, I was overwhelmed,” Noutsou recalled. “I didn’t know which person to
help first because so many people were coming up to me.”
MSF
is the only aid group with specialist teams dealing with severe mental health
cases for those displaced from Mosul.
Bilal
Budair, MSF mental health manager in Erbil – the de facto capital of Iraqi
Kurdistan – said his teams had even stopped doing outreach activities in Debaga
because so many camp residents were knocking on their doors (although they do
similar work elsewhere).
“People
are suffering, and their suffering has led them to go to our services,” he
said. “We receive many patients on a daily basis.”
More
than Mosul
It's
easy to focus only on the big battles, but Iraqis throughout the country are in
need of assistance.
This
is laid bare in Abu Ghraib, a Baghdad suburb best known outside the country for
hosting an infamous American prison.
MSF
has a small clinic there made up of several caravans.
When
IRIN visited at the end of October, mental health support had only been on
offer for a month. Doctor Duniyah Akbar, one of the clinic’s GPs, had been
pressing for it almost since she started a year earlier.
The
reasons for such high general needs are manifold, she explained, in between
appointments – her patients seated in an outdoor waiting area. “With
displacement and low socio-economic status, here in Abu Ghraib you find a lot
of cases of depression, stress, and… a lot of cases of Post-Traumatic Stress
Disorder, especially in people who… fled military operations against [IS].”
Doctor
Akbar said that while a few of her patients were concerned how their families
might view treatment, most were just keen to get better. In fact, she thought
patients with epilepsy suffered greater stigma than those with psychological or
psychiatric diagnoses.
All
her patients were being screened for mental health issues, and plenty had
referred themselves to a nearby caravan – decorated with posters about the
causes and symptoms of anxiety – where two women were waiting to see a
psychologist.
Skills
shortage
There
are simply not enough trained clinical psychologists in Iraq to deal with the
needs. The country itself doesn’t offer clinical psychology as a degree,
although the KRG does have courses.
In
addition to MSF's teams and those connected with other aid agencies, there are
only around 80 clinical psychologists working in Iraq and Iraqi Kurdistan, up
from 47 in 2010, according to official figures. There are more psychiatrists –
some trained in techniques like Cognitive Behavioral Therapy – but they are
overworked too.
Doctor
Ahmed al-Rudaini, an Iraqi health ministry spokesman, agreed that mental health
care was “very important these days”, but it was clearly not his government’s
main priority.
“We
are focusing on saving people’s lives and providing surgeries and first aid
treatment in the areas of operations [against IS], rather than focusing on
psychological issues,” he said.
The
government has plans to “train and encourage and educate people about the
importance of such fields,” but this, al-Rudaini added, “needs time”.
Some
aid agencies, including the UN’s refugee agency, UNHCR, are trying to fill
at least some of the gap by training aid workers in what’s called
“psychological first aid”.
“Staff
are trained to carefully listen to families, allow individuals to discuss what
they have gone through and identify their needs, followed by immediate
referrals to service providers,” a UNHCR spokesperson explained in an email.
Psychological first aid isn't meant to replace treatment, but can be a useful
tool in the aftermath of a traumatic event.
MSF
is also training new staffers in these techniques. But not everyone is good at
listening and talking, Noutsou pointed out, highlighting the need to find the
right people.
It
was easy to see why Rasha was one of those MSF had selected to train up in
psychological first aid. At the Abu Ghraib clinic, IRIN found her administering
questionnaires to patients and helping them schedule appointments.
The
29-year-old was easy to talk to and had the sensitivity to move even a
whispered conversation about patients outside the quiet waiting room. In only
three weeks at the clinic, she had already heard plenty of stories she wanted
to forget.
“Most
of the people who come here have attempted suicide already,” Rasha told IRIN,
mentioning a young woman who set herself on fire because of ongoing family
problems.
Many
patients want to talk about divorce, stress, and depression, she said. “Some
people are shy, and others love to talk and come here just to seek help from
our psychologists.”
Less
stigma?
A
unique positive to take from the situation is that the stigma surrounding
mental illness in Iraq appears greatly diminished.
MSF’s
Noutsou believes it is partly the scale of the trauma that Iraqis have
been subjected to over the past two years, since IS entered the country in
January 2014, that has broken the seal of shame.
"'We’ve
been through wars… we know war,’ she recalled patients telling her. ‘This is
unprecedented. This, we have never experienced this before.’”
Hussein
Shaati, a psychologist at Abu Ghraib, told IRIN that mass displacement – currently hovering at around three
million – also played a role, in that a lack of local and/or family support
systems meant many were now forced to overcome any stigma they might previously
have felt.
“They
were supported,” he said. “But after trauma [and displacement]… they have to go
and seek help.”
This
idea was echoed by Rasha, who said several patients had told her that any care
they once had had gone.
But
therapy doesn’t necessarily bring the immediate relief of a pill. And doctors
told IRIN that convincing patients in Iraq to keep coming back for repeated
appointments was still a major hurdle.
It’s
not just that, MSF’s Budair’s pointed out. “You are treating patients at the
same time war is still going on… [One of the main] challenges to our activities
is treating patients while the war is running. Many are worried about their
family in Syria or in Mosul, and this creates a lot of anxiety. We have
patients with multiple diagnoses.”
In a
recent statement, MSF said that as the battle for Mosul drags on, the severity
of the events patients describe increases.
And
while witnessing public beheadings certainly causes trauma, that isn’t the
right term for everything MSF is dealing with.
Both
Noutsou and Budair told IRIN they see many people with pre-existing conditions
that have gone untreated for the past two years: depression, bipolar disorder,
anxiety, marriage issues.
Budair
was frank about the future, adding simply: “We are expecting to see more
patients.”
(Additional
reporting by Samya Kullab)
(TOP
PHOTO: Rasmiyya, 65, wipes a tear from her eye as she recalls the story of
losing her leg, as she sits in her tent in a camp for internally displaced
Iraqis in Dhuha al-Rawii in Baghdad’s western Mansour district on July 22,
2015. Ed Ou/UNHCR)
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