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Last Updated: Friday, 12 August, 2005, 16:55 GMT 17:55 UK
War takes toll on Iraqi mental health
By Richard Allen Greene
BBC News

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.

Children react after US soldiers fired on a car they were in, killing their parents
Iraqi children have seen their parents killed before their eyes

"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.

If someone had flashbacks, nightmares, nerves, there would be nowhere for them to seek help
"Youssef", Basra doctor

"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 abuse.

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 respect.

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.

An Iraqi doctor treats a patient wounded in a bomb attack
Doctors faced poor conditions and traumatised patients during the 2003 conflict
"Mental health has not been a priority in terms of money or equipment," he says.

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 themselves.

"They were all wound far too tight and experiencing all these new emotions that come with an invasion."

Hopeful signs

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 Middle East.

Infrastructure like universities and nursing colleges is still in place, he says - they only need people to fill them.

"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 years."

On Thursday, BBC News talks to UK veterans.

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