Monday, March 19, 2007

BAGHDAD — Iraqi psychiatrists are seeing what they call a disturbing spike in mental health disorders as terrorism, an armed insurrection and a bloody sectarian divide grip the country. Escalating psychiatric caseloads are compounded by Iraq’s lack of mental health workers, facilities and services.

Several mental health care professionals say the number of untreated or undertreated people nationwide reaches into the millions, and the consequences could permanently damage generations.

“Iraqis are being traumatized every day,” said Said Al-Hashimi, a psychiatrist who runs a private clinic and teaches at Mustansiriya Medical School in Baghdad. “No one knows what will result from living through this continuous trauma on a daily basis.”

The government-run Ibn Rushd psychiatric center in the Iraqi capital provides startling examples of people looking for help.

In a sparsely furnished office at the hospital, Iraqis file in to describe their ailments to Haider Adel Ali, a somber psychiatrist.

Fanzia Jaafer, a 65-year-old housewife, has suffered from severe depression and suicidal thoughts since viewing the corpse of her son, whose head was nearly torn off by gunfire in late 2003.

Sundes Al-Dulaimi, 27, said she has suffered chronic headaches, insomnia, loss of appetite and panic attacks after her 55-year-old father was killed by a Shi’ite militia in June.

Zaman Al-Keelany, 15, has experienced flashbacks of a rocket destroying a building in her neighborhood. The high school freshman said she has managed to continue her studies but breaks down whenever she hears a loud noise.

Although there is no reliable research on the state of Iraqis’ mental health, the preliminary results of a survey of 10,000 primary school students in the Sha’ab section of northern Baghdad, conducted by the Iraqi Society of Psychiatrists and the World Health Organization, reveals startling and widespread problems.

The study, which has not been published, found that at least 70 percent of students were suffering from trauma-related symptoms, said Mohammed Al-Aboudi, Iraq’s national mental health adviser.

Dr. Al-Aboudi said the survey was repeated because of the unusually high numbers. The second results were similar.

Ten-year-old Ahmed Al-Dulaimi is one of the young Iraqis struggling to function.

Ahmed, who enjoys playing soccer and is computer savvy, stopped talking and refused to eat or drink when his family moved last year from their western Baghdad home to Fallujah for three months after receiving a threatening letter with a bullet enclosed.

They have since returned to Baghdad and say Ahmed’s condition is improving. But Ahmed is still receiving treatment at Ibn Rushd, and Dr. Ali, has prescribed antidepressants and advised his family to prevent Ahmed from watching violence on TV.

“I look into the eyes of children whose parents have been killed or are imprisoned every day,” said Nadal Al-Shamri, a pediatrician at the Medical City health complex in Baghdad. “The psychological trauma is so deeply ingrained in some children that they may never lead a normal life.”

Dr. Al-Shamri said his 7-year-old son suffered an apparent nervous breakdown last year and stopped eating after a friend’s father was killed.

“It’s difficult for me to eat after watching him cry,” Dr. Al-Shamri said.

Iraq’s psychiatrists, like most medical professionals here, are suffering from shortages in training and funding. There are no psychotherapy or crisis centers, and Ibn Rushd is the only psychiatric hospital in the capital of 6 million people.

Patients at Ibn Rushd receive free treatment and medication, but those who can afford care at a private clinic pay about 5,000 Iraqi dinars, nearly $4, for visits that usually last 30 minutes to an hour.

A shortage of prescription medicines has resulted in a Health Ministry order limiting treatments to 10 days.

There is a similar shortage of psychiatrists, who are among the professionals and intellectuals making a mass exodus from Iraq in response to a campaign of intimidation against them.

Dr. Al-Aboudi, who also heads the Iraqi Society of Psychiatrists, estimates that at least 140 of the country’s 200 psychiatrists either were killed or fled in the past four years.

Dr. Ali, who earns only $300 monthly, is among the psychiatrists determined to remain, and he has the scars to prove his courage: two bullet wounds in his right arm from an assassination attempt at his clinic last year.

Remarking on Iraq’s diminishing psychiatric resources, he said, “There is little interest from the government. We ask for training and assistance but get nothing.”

While seeing a string of patients one morning last month, Dr. Ali offered advice, prescriptions and, perhaps most important, compassion.

Mrs. Jaafer, the housewife with suicidal thoughts, was cloaked in a traditional black abaya and clutching a white tissue in her right hand as she sat on a chair adjacent to Dr. Ali’s desk and described the difficulties of coping with the death of her 29-year-old son, Haider, more than three years ago.

“Whenever I remember seeing his body at the morgue, I start to cry,” she said.

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