(Updating to add health ministry figures for psychiatrist numbers, paragraph 17)
By Katie Nguyen
LONDON (AlertNet) - Post-conflict Iraq has made some progress in addressing the needs of people suffering mental health problems – a large but often overlooked group - but there is much more to be done, an Iraqi-born psychiatrist says.
"The fabric of society is really tested to the limit. There are clearly some efforts to rebuild the country, particularly in the health services," said Dr Mohammed Al-Uzri, a UK-based consultant psychiatrist and honorary senior lecturer at Leicester University.
"This goes some way to reducing the treatment gap, but the burden of the difficulties is being dealt with by the society, within families coping and supporting each other," he told AlertNet in an interview.
Iraqis had suffered decades of dictatorship, conflict and international sanctions before U.S. troops led an invasion in 2003 and toppled Saddam Hussein.
Tens of thousands of civilians were killed and millions fled their homes during the invasion and the subsequent sectarian violence. The conflict shattered Iraq’s infrastructure, caused an exodus of doctors and other professionals, crippled the health system – once one of the best in the region - and left millions dependent on food aid.
Violence, though less severe than during the sectarian slaughter that erupted in 2006-2007, remains endemic and there are frequent suicide bombings.
The only mental health survey of recent years, the Iraq Mental Health Survey carried out in 2006-2007, recorded the damaging effects of the violence on Iraqi people.
It showed that mental health disorders were prevalent in 13.6 percent of Iraqis aged 18 and above in that year. Anxiety disorders were the most common type of mental disorder followed by mood disorders, which might manifest themselves as depression.
The survey showed that 56 percent of the population had been exposed to trauma. The most common causes were raids by police or the army, followed by shooting, internal displacement, being a witness to killing, exposure to bomb blasts and the death of a close relative or friend.
QUICK TO ANGER
Al-Uzri, who makes frequent visits to Iraq, said there was often an increase in the awareness of mental health problems in a post-conflict situation. In Lebanon, the prevalence of mental health disorders was as high as 17 percent in 2002-2003, a decade after the civil war had ended, he said.
"It seems that post-conflict - when people start rebuilding their lives and the threat to their survival is lifted or at least reduced, people start paying attention to the quality of their lives - that's when the consequences of conflict emerge," he said.
"What I see when I go to Iraq (are) anxiety symptoms and increased vigilance. People can be upset very quickly. They can get angry very quickly."
Disorders of this sort are much harder to detect, diagnose and measure than more recognised problems such as schizophrenia or bipolar disorder, Al-Uzri said.
"This is less tangible. It is harder to measure but you can feel it when you go there and relate to people in the street, in the coffee shops or in the neighbourhood," he added.
Fewer than 11 percent of the people surveyed who needed treatment had received any, he said. Of this number, only one third had received treatment from mental health services. The others had relied on general medicine and spiritual leaders.
"There are more resources since the time of the survey but these are tentative steps. We still have a long way to go in terms of meeting the needs of the population," he said, pointing to the important role volunteer mental health specialists can play.
For a population of more than 31 million, Iraq has only 84 psychiatrists and about 22,000 physicians, according to the Costs of War Projectby the Watson Institute for International Studies at Brown University. Iraqi health ministry figures from 2010 put the number of psychiatrists and doctors working in psychiatric settings at 260.
Beside coping with the challenge of treating more people, mental health professionals are also trying to tackle the stigma attached to mental health disorders.
"What you find in Iraq and possibly with other Muslim countries (is a) preoccupation with being possessed when talking about patients with mental illness. I am not sure what's worse - being labelled as mentally ill or being labelled as possessed by the djinn or Satan. This is the kind of stigma that people have to live with," Al-Uzri said.
Awareness of mental health problems has improved in recent years, al-Uzri said. Some of his colleagues have gone on radio shows to discuss them. Another replies to questions on the subject with advice in a newspaper column.
"I think people are more able to talk about mental health now," Al-Uzri said.