It's time we acknowledge Iraq's mental health crisis

It's time we acknowledge Iraq's mental health crisis
Comment: Iraq must de-stigmatise mental health treatment or risk the shared experiences of war trauma taking over the county's wellbeing, writes Sophia Akram.
6 min read
18 Mar, 2016
Aid workers and others are concerned with the psychological effects of conflict [Getty]

The Iraqi people have lived through decades of war, repression and dictatorship.

The Iran-Iraq War, two Gulf Wars, Saddam Hussein's tyranny, the ongoing insurgency and political "transition" and now the Islamic State group.

Iraq's sectarian make-up and former secular regime has made it a hotbed of tension, even by Middle East standards. When periods of hostility have ceased, however, what is left for civilians to deal with is something perhaps intangible, something that may emerge only after physical wounds have healed.

If continued unnoticed, this intangible "something" can have startling effects on the infrastructure and social fabric of a country.

Mental wellbeing

Among a new dynamic and pattern of conflict, there is more displacement than ever. Displaced persons lose everything, leaving their homes with the minimum, experiencing harrowing journeys, with health concerns becoming immediate.

The humanitarian priority for first-responders is to deal with what can be seen - food, shelter and medical care.

Increasingly, however, aid workers are becoming concerned with the psychological effects of conflict and displacement - and greater awareness of this as a concern needs to be raised.

The case of Iraq

AMAR is one organisation that has been looking advocating mental health rights since the height of troubles in Iraq in 1991. It set up clinics to help people deal with the trauma of war, since Saddam's regime left a fragile social infrastructure with poor medical provisions.

Estimates have found that nearly one in five Iraqis suffer from mental illness, which would exceed the numbers necessary for an epidemic if it were influenza or another physical disease.

Other country case studies have shown how traumatic incidents - genocide or the violence associated with apartheid, for example - have affected the collective memory of a country, and how this can alter the relationship of society with its institutions.

In Iraq's case, however, we're talking about cumulative hardships, wars, displacement (there are 3.3 million Internally Displaced Persons in Iraq) - and that trauma, if not addressed or confronted straight-on, will undermine the capacity of the country to heal and grow.

Many have suffered the trauma of seeing loved ones die or being kidnapped

In Iraq, displaced people who have witnessed unspeakable brutalities may lose the ability to hold down jobs, or provide for their families, despite having once held good jobs and decent lives.

There are an estimated five million orphans in Iraq, and the prevalence of mental illness among this group of children - particularly street children - is much higher than it is among the adult population.

Many have suffered the trauma of seeing loved ones die or being kidnapped, or have themselves survived kidnap, torture, rape or trafficking. The Yazidis, having survived what many international groups have described as a genocide, have endured rape and enslavement and watched family members slaughtered. The need to reconcile this suffering with a hope for the future is critical.

Collective memory

History rarely acknowledges the psychological impact of war, but the trauma of conflict has a very large role to play in art, politics, economics and other daily life.

As well as clinicising psychological impacts of war, we can use collective experiences as an historical function. This function illustrates how other societies have been damaged by war and its psychological violence.

Think of Iran after the Iran-Iraq war, a generation of internalised and repressed anxieties, nightmares and memories. The conflict created 60,000 victims of chemical warfare, with many survivors exhibiting a variety of psycho-social disorders such as alcohol abuse, drugs and suicide.

However, beyond these clinical diagnoses, Iranians saw a world that moved on with no regard to the trauma suffered by so many. This affected Iranians' relationship with the rest of the world.

One form of psycho-social trauma is violence. Many have described, for instance, South Africa as having a culture of violence - perhaps due to its history being characterised by violence from the days of colonisation through apartheid, during which the most documented form of violence was political violence - violence that impacts on power relations.

Arbitrary arrests, detention without trial, civil unrest, acts of sabotage, harassment, torture, "disappearances" and assassinations marked this period and was mostly conducted by the state. Structural violence - racism and deprivation - which underpinned the apartheid system, was responsible for unequal life chances in South African society.

Today, South Africa is still enduring violence - rape, carjackings, assault, robbery, murder and vigilantism. Experts believe that victims of violence often are at risk of becoming perpetrators if their suffering is not dealt with.

At such times, summary justice may seem a quicker and more effective remedy than official routes, after  as little faith remains in the criminal justice system perhaps through having been mistreated by the very system that was supposed to be protecting them in the past.

Bosnia 24 years ago endured Europe's worst violence since the Second World War. Former fighters as well as ordinary civilians, including displaced persons, victims of sexual abuse and detainees, are still living with the psychological consequences of the war.

Many Bosnians, on returning to their towns and villages, have had to face the same people that abused them or killed their families. The daily trauma and its associated fear, stress, anxiety and depression can't be denied.

Some of the issues Bosnia now has to face include underage delinquency and football hooliganism, likely exacerbated by political alienation and a middle-aged generation still coming to terms with its experiences of violence.

Iraq's coping capacity

Dr Remos Papidopoulos has described the need for psychological assistance in Iraq in relation to "Refugee Mental Health", although his work is not only relevant to refugees but to all those that have experienced severe adversity as a consequence of war, such as the Yazidis.

Papidopoulos said that there were three responses needed from assistance for the most severe disorders to dealing with the psychological effects of stress and distress, to psychosocial assistance such as appropriate community support and normalisation.

All three responses need to be embedded in everyday life to avoid creating identities of victimhood that outlive the initial stages of a humanitarian crisis.

In Iraq there is a desperate need for psychologists to deal with refugee mental health - experts say around 5,000 are needed - but there are only 400 in the country.

There is no reliable data because researchers' access is restricted due to ongoing hostilities

Orkideh Berouzan in Foreign Policy made a very valid point that psychological issues - though sidelined in policymaking and analysis - shouldn't be ignored, because of their undeniable impact. These questions are at the core of what policy is meant to address.

Good health is a human right as defined by Article 25 of the Universal Declaration of Human Rights. While the most recent mental health survey revealed almost 20 percent of the Iraqi population suffering from some form of mental ill-health, there is no reliable data because researchers' access is restricted due to ongoing hostilities.

More research is needed, not just for the numbers but to begin implementing coping strategies. But the stigma attached to mental illness prevents many Iraqis from dealing with their problems.

Psychological health assistance needs to be mainstreamed into health policies and responses, particularly post-war plans to prevent care being overlooked as an afterthought.

Initiatives must receive sufficient funding to deal with Iraq's national mental health crisis, which is likely to manifest in further societal problems as the relationship of the Iraqi people with its future is altered.

Sophia Akram is a researcher and communications professional with a special interest in human rights particularly across the Middle East. Follow her on Twitter: @mssophiaakram

Opinions expressed in this article remain those of the author and do not necessarily represent those of The New Arab, its editorial board or staff.