Iraq's Crisis of Scarred Psyches

By Jonathan Finer and Omar Fekeiki
Washington Post Foreign Service
Monday, March 6, 2006

BAGHDAD -- More than 25 years after Saddam Hussein's rise to power ushered in a period of virtually uninterrupted trauma -- three wars, crippling economic sanctions and now a violent insurgency -- the psychological damage to many Iraqis is only now being assessed, psychiatrists and government officials here say.

Even as a grim, though incomplete, picture of the population's mental health has emerged in recent studies, so too has the realization that the country's health care system is ill-equipped to deal with what are likely millions of potential psychiatric patients with conditions born of the hardship of recent years.

One recent study was sparked by one of the country's darkest days in recent memory. Last Aug. 31, nearly 1,000 Shiite Muslim pilgrims died -- some trampled in a crush of humanity, others by drowning -- when a religious procession across a Baghdad bridge became a lethal stampede.

Months after the dead were buried and the wounded had begun to heal, a team of psychiatrists at the Health Ministry established a psychological outreach facility in Sadr City, a teeming Shiite slum in the capital, to assess and treat the damage inflicted on victims, witnesses and their families. What they found surpassed even their worst fears. More than 90 percent of the people surveyed suffered from psychological disorders, including depression, insomnia and post-traumatic stress disorder, or PTSD.

"The people we've identified as troubled are just the tip of the iceberg in terms of the mental health situation in this country," said Ali Abdul Razak, 55, who runs the clinic in a dank corner of Sadr City's Imam Ali Hospital. "I don't consider this post-traumatic, I consider it 'continuous traumatic,' because the trauma they have is ongoing."

Resources for treatment are scarce. Only about 75 psychiatrists remain in a country that has endured a brutal eight-year war with Iran and two wars with the United States, along with crippling economic sanctions in the 1990s and the bloody insurgency today. Many fled along with other professionals to escape kidnappings and threats from insurgents. As a result, there is one psychiatrist for about every 300,000 Iraqis, compared with about one for every 10,000 Americans. There are currently no child psychiatrists in this country of about 25 million, Razak said.

This year the Health Ministry declared mental health a top priority and opened two psychological outreach centers in Baghdad (the second is in the city's main teaching hospital in the predominantly Sunni Muslim neighborhood of Yarmouk). In addition to studying those affected by the bridge collapse, the ministry has begun collecting data on the population as whole.

In a survey of just over 1,000 randomly selected people across five Baghdad neighborhoods, completed this month by psychiatrists at Baghdad's Mustansariyah University, about 890 reported having experienced a violent incident firsthand, including all 27 children under 12 in the sample.

Most alarming, according to the physicians who analyzed the data, was that exposure to trauma has grown dramatically more common since the U.S.-led invasion in 2003. The people in the study recalled 3,504 violent incidents between 1979, when Hussein came to power, and 2003. Since the invasion, they have recorded 6,463.

In the survey, the psychiatrists adapted an Iraqi version of the Harvard Trauma Questionnaire, a research tool once used to evaluate the mental health of Southeast Asian refugees displaced by war.

Among the 42 yes-or-no queries, Iraqi subjects were asked to indicate whether they had been "oppressed because of ethnicity, religion or sect," "witnessed the desecration or destruction of religious shrines," "witnessed mass execution of civilians," been "used as a human shield," "witnessed rotting corpses," or been "forced to pay for a bullet used to kill a family member."

Those at the greatest risk, psychiatrists say, are people who came of age during Hussein's reign and have rarely known a life without trauma.

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