By Richard Allen Greene
The invasion of Iraq put an end to decades of repression under Saddam Hussein, but it also took a physical toll on the country, with hundreds of thousands killed or wounded. The war has also caused other wounds that are harder to detect, experts say. In the third of a five-part series, BBC News investigates the psychological trauma that may echo through Iraqi
society for years to come.
"Iraq's largest psychological hospital - which had more
than 1,500 beds - was destroyed in the war," says Dr Majid al-Yassiri, chairman of the London-based Centre for Psychosocial Services in Iraq.
"The staff has left, patients have left because there
was no food or medicine, and female patients in
particular were subjected to rape."
Baghdad has another psychological hospital, Ibn
Rushed, but newspaper reports say it has only two
doctors and 74 beds.
Another problem is that many Iraqis are reluctant to
admit to mental health problems.
"There is a stigma," he says. "Women in particular are
less likely to seek help unless they become psychotic
or suicidal, because of the fear of being seen as mad
and not being able to marry."
There has been no large-scale study of mental health in Iraq since the 2003 invasion, but experts say what little data they have are not encouraging.
Effects on young
"Children in particular are showing behavioural problems and depression at a higher rate than one would expect in a population this size - three times as high," Dr Yassiri says.
And children are not the only ones affected.
"The impact of torture, war, continuous trauma and
bereavement will take its toll on families," he says.
His organisation helped establish a centre for victims
of torture in Baghdad, which has seen about 300
patients since it was founded 18 months ago.
Its patients have a range of problems from paranoia
and delusions to depression, loss of appetite and drug
While its mere existence may be a positive step
towards a healthier society, it has had problems with
funding and security - and it is not alone in that
Doctors in danger
And doctors have been a particular target for
kidnappers and murderers, Dr Yassiri says, making it
ever more dangerous for them to treat patients.
He estimates that half of Iraqi psychiatrists have
left the country or are not working.
"Mental health has not been a priority in terms of
money or equipment," he says.
Doctors faced poor conditions and traumatised patients during the 2003 conflict
Medical doctors agree.
"Youssef", a doctor in Basra who asked that his real name
not be used for security reasons, says a person who went to a doctor complaining of psychological problems would be treated as "a lunatic".
"If someone had very severe psychological problems as a result of the war - flashbacks, nightmares, nerves, there would be nowhere for them to seek help," he said.
"There are very few psychologists here in Iraq," says
Khalid, a Baghdad surgeon who asked that his surname be withheld.
"Being operated on physically is the most important.
No-one had - or has - time to ask: 'Are you afraid?
Are you stressed?'"
He had the impression that soldiers in Saddam
Hussein's army needed some kind of counselling.
"All the soldiers came back upset from the war. Many
were sad and all too many ran away.
"We saw them and would say: 'Why didn't you defend
us?' I think most were too busy trying to defend
"They were all wound far too tight and experiencing
all these new emotions that come with an invasion."
But the situation is not hopeless, Dr Yassiri says.
A national commission for mental health services has
been appointed, and is working with Britain's Royal
College of Psychiatrists.
Training programmes are being organised, and small
numbers of future mental health practitioners are
being trained in Jordan and the UK.
And Dr Yassiri points out that before Saddam Hussein,
Iraq had one of the best health care systems in the
Infrastructure like universities and nursing colleges
is still in place, he says - they only need people to
"There are efforts to organise research looking at
mental health services, what would be feasible
economically and culturally," he says.
"There are a lot of things happening. But it will take
On Thursday, BBC News talks to UK veterans.