IRAQ: Baghdad psychiatric hospital struggles to care for patients as doctors and medicines are in short supply

Baghdad's largest psychiatric hospital is admitting patients after refurbishment, but shortages of psychiatric consultants and anti-psychotic drugs make it difficult to care for them. It has been more than 26 years since Saddam Hussein rose to power in Iraq and brought with him a period of virtually uninterrupted trauma for the population which included three wars, crippling economic sanctions and currently, a violent insurgency which is claiming the lives of hundreds of people almost on a daily basis. The situation in Iraq is grim and although there is no official survey available, doctors say the events of the last 26 years have had an detrimental impact on the mental health of the Iraqi population. The fact that Iraq's health care system is ill-equipped to deal with a large number of potential psychiatric patients with conditions born out of the hardships of recent years is only adding to the problem. In the courtyard of the men's ward of Baghdad's al-Rashad Hospital, Iraq's only facility providing long-term care for patients suffering from chronic schizophrenia and other mental disorders, patients squat on the ground and lean against the walls, many of them visibly disturbed. Others wander aimlessly around the courtyard in flowing robes and with bare feet. The International Committee of the Red Cross (ICRC) oversaw in 2000 the renovation of al Rashad's buildings and gave new medical training to the staff. The $3.5 million (USD) project saw the hospital fitted with new air conditioners, furniture and beds. The new training scheme introduced by the ICRC brought staff up to date with the latest psychiatric treatments, and resulted in the introduction of occupational therapy workshops. But like other hospitals throughout the city, al-Rashad was stripped bare by looters in the days following the fall of Baghdad and the majority of its patients fled. Now back in business, the hospital suffers from a shortage of prescription medication coupled with a similar shortage of psychiatrists, many of whom are among the professionals and intellectuals leaving Iraq in response to a campaign of intimidation. "A large number of doctors have left Iraq because of the deteriorating security situation. As you may know, doctors are targeted and in many cases no one knows the party which is targeting them. This, in consequence, has promoted doctors to leave Iraq. Hence, we are now suffering a shortage of doctors," says Jawad Kadhim, a psychiatrist who works at the hospital. According to hospital sources, there are more than 1000 in-patients at the hospital who are being cared for by 50 nurses and 10 psychiatric consultants, along with a dozen trainees. Doctors at the al-Rashad hospital say the international standard is one psychiatrist to every 6 patients, but the Iraqi average is one psychiatrist to every 60 patients. One of the reasons for the shortage of psychiatrists is that insurgents frequently target Iraq's medical professionals. Another reason is that many Arabs consider mental health issues to be a socially taboo subject and as a result, many of those suffering from psychiatric problems never receive treatment. This also explains why even before the fall of Saddam Hussein, there was always a shortage of psychiatric doctors in Iraq. Before the 2003 U.S.-led invasion, there were nearly 100 psychiatrists working in Iraq serving a country of 26 million people, a tiny fraction of what one would expect to find in a Western country. Another problem for patients at al-Rashad, and one that is further impacting their mental health, is their isolation and lack of communication with their families and loved ones because of the security situation. Fadhil Hussein, who has been receiving treatment at the hospital for 14 months, says his family has not been able to visit him in a long time. "They [relatives] used to come but they have stopped it now," he says. "They cannot come because of the gunmen on roads and also because some of the roads are blocked," adds the 44-year-old, who suffers from aggressive behavior and nervous fits. Doctor Jawad Kadhim believes the lack of communication between the patients and their families is also affecting their treatment. "In the past, a large number of patients admitted to the hospital were from the provinces and definitely communication between the patient and the family of the patient was maintained. Due to the current deteriorating security situation, families usually cut communications with the patients once they brought them here because it is hard for them to come. Therefore, he or she [the patient] is abandoned here and as a result, they feel like a victim," says Kadhim. Al-Rashad hospital has 1,000 beds for long-term patients and provides free treatment apart from a charge of 500 Iraqi dinars ($40 USD) for their first psychiatric evaluation. The hospital also encourages patients to take up painting and embroidery as a way of training and improving their mental abilities. "I am painting here a lot and I'm not doing this for financial gain, but to help train my mind and to get rid of the depression I've been suffering from for more than 12 years," says Dhiya Muhsin Jassim, as he paints in a workshop attached to men's section. Jassim who is from the southern Shi'ite-province of Dhi Qar says he has not seen his family since he was admitted to the hospital after Saddam's fall in April 2003. The full impact of the current violence in Iraq on the mental health of its population may not be evident for years to come. Stress related illnesses such as post-traumatic stress disorder, or PTSD, sometimes don't appear for years or even decades after a person is exposed to the stress that caused them. Several charities and foreign governments are providing training for Iraq's doctors and mental health workers. Many of the country's existing hospitals and clinics are decrepit and need to be renovated.

ITN Source | August 15, 2007

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