Our contacts with Iraq came after the American army invaded the country and removed Saddam Husain. Teams from the International Center for Psychosocial Trauma were not allowed into Iraq because of the danger. Instead physicians were brought to adjoining countries for training conferences on the recognition and treatment of post-traumatic stress reactions. Meetings were held in Kuwait, Jordan, Turkey and United Arab Emirates. This first report is the center’s initial contact with Iraq physicians in 2003. The final report in this series on Iraq will be an attempt to explain the suicide attacks by the insurgents.
Even though Dr. Arshad Husain, as the director of the International Center for Psychosocial Trauma, had been to most of the major zones of conflict in the since 1994 years, he found the stories of torture and abuse told to him by the Iraqi physicians who were participants in this training program among the most disturbing he had encountered. He told me that "The stories of Saddam Hussein’s terror tactics I heard from Iraqi psychiatrists caused me to have symptoms of post-traumatic stress.”.
Arshad had met with the group of psychiatrists from Iraq in Kuwait, along with an international array of mental health workers for a round-table discussion of "Iraq’s Mental Wellbeing: Training and Educational Workshops." The program had been sponsored by the USA Marafie Foundation. The opening ceremony speaker was Ambassador Nathaniel Howell, U.S. ambassador to Kuwait during the Gulf War and chairman of the Marafie Foundation board.
Many patients reported suffering multiple psychiatric problems because of Saddam’s reign of terror. One woman in treatment had been the mother of a highly placed minister in Saddam’s government. During the war with Iran, Saddam had been especially cruel to Iraqis who were Shiites, which pushed them to favor Iran. The minister suggested a more moderate approach, including the suggestion that perhaps Saddam should consider resigning. His position was no protection from Saddam’s anger, and his dismembered body was returned to the mother.
Another patient’s son had been randomly arrested, tortured and then brought back to the family. The mother was given the choice: She could either shoot her son or the rest of the family would be arrested over time, tortured and killed. After shooting her son to save the rest of the family, the woman became extremely depressed and suicidal. The intent of these actions was to demoralize Iraqis who might consider doing anything to remove Saddam.
Clearly no one was immune from the terror campaign, Arshad said. "At first the psychiatrists from Iraq were very guarded, almost to the point of paranoia. They did not even trust the men who had come with them to the meeting."
Saddam had spies everywhere, and even family members learned not to trust one another. Iraqis feel that, even in hiding, he had the power to arrange for people to be punished and killed. They reported that until they saw his dead body, they would continue to believe he was a force to be reckoned with.
It seems caution extended to the coalition forces, who allowed only 10 of the 20 Iraqi psychiatrists invited to the conference to cross the Kuwait border for the meetings.
Almost 1,000 years ago, Baghdad started the second mental health facility in history. Before Saddam took charge, the government had been in the forefront of mental health care. More recently, the government had taken a negative stand toward mental health. In one of his speeches, Saddam Hussein said, "Depression doesn’t exist in Iraq; depression is a sickness derivative of Western societies: We are all happy here."
Even under Saddam’s rule, each of the six sections of the country had a psychiatrist running outpatient and inpatient services in either a psychiatric hospital or within a medical ward. Immediately after the war with the coalition, the hospitals were looted of supplies and equipment.
The psychiatrists Arshad met are well intended, but he feels they are not up to date on treatment methods and have much to learn about modern techniques and training mental health workers and teachers to help with the tremendous numbers of people needing psychological help.
Iraq, with a population of 25 million, had only 100 psychiatrists. With half of the people suffering from post-traumatic stress reactions, that’s too few to deal with the ranks of patients needing treatment. Millions of children have post-traumatic stress reactions in a country without even one child psychiatrist. Adding to the hopelessness, many of the psychiatrists plan to leave the country now that Saddam’s restrictions on foreign travel are gone.
What is the present state of affairs?
Almost half of the Iraqi population is younger than 18. UNICEF reported that because of the country’s problems and the sanctions placed after the Gulf War, many children are very vulnerable to disease and malnutrition. One in four children younger than 5 is chronically malnourished. One in eight dies before age 5. Their lower physical resistance also makes them more vulnerable to emotional disorders.
Many parents feel their children are not safe because of abductions, the ongoing conflict and the children of former Ba’athists being targeted for violence. There are widespread complaints that Americans might have brought freedom but that freedom doesn’t mean anything if there is no security and no chance to live normally.
With the history of the war with Iran, the Gulf War, the terror campaign of the government and the U.S. invasion, post-traumatic stress disorder (PTSD) is rampant. Psychiatrists say it affects the children’s ability to learn and their hope and plans for the future.
No help is available. The coalition has developed plans for a national PTSD center in Baghdad, but it is still only on paper. There are questions about how to put this into operation. Iraqis will run it with the funding and support of the coalition.
There was rivalry among the professionals, Arshad said, because some are in line to get money to work with the center and others are not. Turning the program over to the Iraqi psychiatrists might cause some problems because they are out of touch with what has been learned in recent years about treating PTSD. They are following old models of treatment and relying on traditional psychiatric training.
There is an additional problem that even professionals in Iraq have lost much of their creativity and flexibility because of the traumatic conditions under which they have been working. As Arshad said, "Even the professionals are acting like robots."
What are future possibilities?
Many recommendations that came out of the conference struck Arshad as big pie-in-the-sky plans having little to do with reality. His hope for action lie in physician Ayad Fattah, the Iraqi national manager of the mental health program in the Ministry of Health. Fattah is a family practitioner, not a psychiatrist. Given the tremendous scope of the mental health problem, he sees the wisdom of training mental health paraprofessionals and teachers as soon as possible in psychological interventions.
Fattah was impressed with the expertise of the team from UMC’s International Center for Psychosocial Trauma and would like to have made arrangements for them to come and train Iraqis in intervention techniques. Arshad is considering a small pilot study in the schools to learn about the special nature of the problems of Iraqi children. This would be similar to the studies done by the center in Bosnia, Kosovo and Afghanistan.
Where would the training take place? Kuwaitis have abundant negative feelings about Iraq and did not want to cooperate. The southern part of Iraq, on the other hand, was relatively quiet, and Arshad felt a team from the University of Missouri would be safe.
Arshad’s major problem was finding the funding for an operation that would involve bringing a large number of teachers to a central place and hosting them for a five-day training program. Once that hurdle is overcome, the team would be in a position to make repeated trips to further the treatment skills of the teachers and mental health workers. (It was decided that even the southern part of Iraq was not safe and other arrangements were made for where to go for training.)