Unseen victims of war

Mental illness among Iraqi children and adolescents, who make up half the nation’s population, is a hidden problem, an expatriate Iraqi psychiatrist said, adding that the country has few mental health professionals or facilities to help them.

Abdul Kareem Al-Obaidi told a small audience at a Harvard School of Public Health “global chat” last week (April 29) that one of the difficulties in addressing the problem is that its scope is unknown.

While major national surveys of child and adolescent mental health are lacking, he cited several smaller studies that showed increased rates of mental conditions, including post-traumatic stress disorder and attention-deficit/hyperactivity disorder in the cities of Baghdad, Mosul, and Nassiriya. One 2007 study in Mosul, for example, showed that 37 percent of children who were patients at a primary health facility complained of a mental disorder.

Al-Obaidi, whose visit to the United States is being hosted by the International Institute of Education, said many factors work against the mental health of young Iraqis, including being victims of violence, seeing family members become victims, being displaced from their homes, and the instability that still plagues the nation.

The chat was sponsored by the Harvard Humanitarian Initiative. Initiative Director Michael J. VanRooyen, an associate professor at both the Harvard School of Public Health and Harvard Medical School, said many people don’t appreciate the level of risk that Iraqi scholars such as Al-Obaidi are under.

Al-Obaidi left Iraq in 2006 after he received death threats. He moved to Jordan and then Egypt, where he provided informal psychiatric services to the Iraqi refugee community. Al-Obaidi said the violence in Iraq has been so bad for so long that recent bombings, which killed 200 and injured 600, have been dubbed Bloody Sunday and Bloody Friday, joining Bloody Tuesday and Bloody Wednesday from earlier bombings.

“All the days of the week are bloody,” Al-Obaidi said.

No one is immune from the violence. One bombing that struck a nursery killed 60 children.

As a workaday society, Iraq has fallen quite far, Al-Obaidi said. As recently as the 1970s, it had among the best education systems in the region. The decline began in the 1980s under autocratic leader Saddam Hussein, with the Iran-Iraq War, international sanctions, and professionals fleeing the country. Torture was common, and was another cause of mental illness.

After the United States invaded Iraq in 2003, the government’s collapse made it impossible to garner statistics on mental health, Al-Obaidi said. Other statistics, however, show how far Iraq has fallen, with 80 percent of the people living without adequate sanitation, 70 percent without clean water, 50 percent without work, and 43 percent in poverty. Millions of Iraqis live as refugees both inside and outside the country.

Solutions are necessary, Al-Obaidi said, that allow services to get to those in need. More mental health professionals are needed, for a start, he said. The nation has only two mental health hospitals, both in Baghdad. Neither specializes in care for children. In fact, there are no inpatient beds for children suffering mental illnesses.

Despite the need, Al-Obaidi cautioned against just copying services available in the West to jump-start treatment.

“We need to do comprehensive and culturally appropriate services, rather than copying something from the West,” Al-Obaidi said.