According to Dr Elham Al-Douri, "40 per cent of Iraqi children suffer from mental illnesses." She continues to list harrowing facts about the mental and psychological illnesses in Iraq, saying: "The same can be said for 17 per cent of youth. This translates to 5.7 million young individuals who suffer from varying levels of psychological and mental illnesses. Meanwhile there are only 100 doctors in Iraq who specialise in this field."
When Dr Al-Douri speaks, she backs everything she says up with statistics and studies that add a new dimension or aspect to the magnitude of the Iraqi people's suffering on every level. The statement may not be shocking, if repeated by a journalist or writer, or if any of us mentioned it. Perhaps we have already noticed the symptoms, even if we are not specialists in the matter, but we would probably try to act proud and overlook the situation, as is typical of us Iraqis, and try to find a way to continue life, regardless of how difficult it may be. However, hearing this from a doctor with extensive experience in the matter and who is a senior consultant at the British Ministry of Health, it had the effect of someone trying to breathe with a large boulder on their chest that they are unable to move, this is how the attendees at the scientific forum held by the Tadhamun Iraqi Women Solidarity organisation in London, titled "The psychiatric/psychological consequences of war and post-traumatic stress disorder", felt. What future does a country with such a high number of those suffering from mental illness have? How did we reach such a deteriorated situation? What is the remedy?
There are several aspects of the tragedy, some of which date back to the 1980s, the period of the Iran-Iraq war, and the subsequent wars, siege, invasion and occupation. During wars, says Dr Al-Douri, "We often focus on the soldiers and the wounded, but not so much on the living."
The conditions of war create memories and wounds that last longer than the wars themselves; they create painful memories that require decades to heal which causes high rates of mental illness.
The end of the war, in defeat or victory, does not mean that psychological wounds are healed. The living remain the victims of internal invisible wounds and this is a serious problem. It hinders healing, especially in our society that "considers psychological or psychiatric treatment as taboo or shameful. This means that many people are left without support or treatment, which causes side effects that further exacerbate their condition," according to Dr Al-Douri. The succession of wars has led to a lack of recovery time, thus creating generations of Iraqis who only know war.
While the years of war before 2003 caused Iraqis to experience symptoms of depression, frustration, despair and post-war trauma, the US-led invasion of Iraq and the use of the "shock and awe" method, led to a worrying increase of deaths and cases of disability and displacement. The operation to liberate Mosul alone forced nearly two million people to leave their homes in order to escape the horrific situation and the battle turned the city into uninhabitable ruins.
What are the general symptoms that hinder normal life? Dr Al-Douri summarises this by saying, "depression is a growing problem, among other psychiatric illnesses. [Post-traumatic stress disorder] PTSD has also been a very common problem in the last 20 years. This situation arises when a person experiences a life-threatening experience or event. Symptoms include the recollection of vivid memories of the painful event, insomnia, anxiety and a sense of despair and frustration."
As for the psychological impact of the war and homelessness on children, in particular, it has been addressed by Joan Baker, coordinator of the Child Victims of War organisation. She first mentioned the dangers children face during times of war including aerial attacks on civilian areas and forced migration, either with their parents or separated from them. They then become easy targets for trafficking, kidnapping, sexual slavery and forced recruitment. Children suffer from starvation during the siege by armed forces. In addition to this, the targeting of schools leads to missing school, making children feel it is useless to learn. The impact of the climate is also apparent on children, as displaced individuals suffer from harsh climate conditions while they live in temporary tents under the harsh summer heat and bitterly cold winters.
These inhumane conditions cause the child to psychologically withdraw or act aggressively against others in addition to suffer constant anxiety, depression and sleep disorder, as children are afraid to sleep due to shock and nightmares. Some children develop speech disorders and are unable to distinguish between past and present. They recall their horrors all the time and cannot escape from them. They do not focus on learning and the ability to perform everyday tasks and cannot relax because they think that something bad will happen.
Given this situation, what should be done?
"There is an urgent need to include psychiatric care as a part of post-war care plans. This is necessary because the Iraqi health care system and infrastructure have been severely damaged, which has created a shortage of doctors. People need access to mental health care as part of the reconstruction process, which is currently not considered a priority compared to other medical issues. There is also an urgent need to establish mental health care centres." These are suggestions by Dr Al-Douri and are supported by Joan Baker, who believes that mental and psychological care must be provided as a priority in the health care field, as well as social/maternal assistance. In other words, helping to support family stability, which is essential to provide a safe environment for children.
This is where the importance of quick action to return displaced families to their homes comes into play, as the stability of a family and the children's return to their schools represents the core of social stability. Joan also mentions the importance of schools being effective in the process of the care and rehabilitation of children psychologically and mentally as a first step in the rehabilitation of society.
Finding a true remedy for mental and psychological illness, which is sure to spread amongst a large part of society that has been exhausted and burdened by wars and invasions requires government initiatives for individual and collective therapy. It also requires individual initiatives, as well as urging international organisations to lend a helping hand. Such efforts complement each other, as the magnitude of the tragedy is too great for just one party to address. There is also a need for a safe environment without war. This is not an impossible task, as modern history has given us examples of nations that have recovered after devastating wars, such as Germany, Japan and France. The important point is the presence of a state intention to do so, based on faith in the people and an end to the spirit of revenge. This is what we are currently missing.
This article first appeared in Arabic on Al-Quds Al-Arabi on 19 September 2017
The views expressed in this article belong to the author and do not necessarily reflect the editorial policy of Middle East Monitor.