Mental illness and Psychiatry are both frontier areas of medicine and are still gaining ground in both developed and developing nations. In Iraq, an estimated 18.6% of the population suffers from mental illness, that is 5.9 million people. WHO estimates that mental illness is the fourth leading cause of poor health for Iraqis over 5 years old. This high rate of mental illness is a result of trauma from years of violence, and ongoing political and security instability.
The tragedy and violence of war has rocked the state of health care in Iraq. Though the country was able to emerge from civil war and re-establish some of the stability it had lost, health services have continued to deteriorate in Iraq. A research study done by public health doctors from Imperial College London and Wayne State University in Michigan, concluded that despite strong investment in the Iraqi health care system, health in Iraq will continue to decline until, “improvements in housing, water and sanitation, electricity, transport, agriculture, education and employment,” are made. The many Iraqis living in make-shift housing do not have resources like proper housing, access to water and sanitation, and electricity, and are therefore more susceptible to health-related illness. The addition of 1.2 million Internally Displaced Persons from the recent security crisis into camps across Iraq presents an increasing demand for improvements to be made in health care services.
The availability of mental health care in Iraq is not on par with the need it presents. Iraq has a total of three mental health care facilities with two in the city of Baghdad, and one in the city of Sulaimaniyah. Psychiatry as a profession is also not highly pursued, and seemingly discouraged in comparison to other fields of medicine. Psychiatry is not given priority in medical studies, and is often put last on the schedule for lectures on a given day at a university medical program. This is partially the case because since psychiatric facilities are so limited in Iraq, the profits from that field of medicine are lower in comparison to others fields. In Iraq, the categorization of psychiatry as luxury medical care is another reason that psychiatry is not profitable as a medical business and not seen as a “need”. Last but not least, the social stigmatism of the mentally ill is a major reason why its practice is unpopular in Iraq. Societal treatment of mentally ill persons and their families can be embarrassing and alienating, which leads some family members to leave their mentally ill loved ones in psychiatric facilities after their recovery period has ended because they fear the backlash of their societies. This adds to the health care crisis because outpatient hospitals are being filled with patients ready to return to their homes, leaving new sick patients without a place to receive treatment. Education on mental illness is necessary to reverse the trend of condemning mentally ill patients and their families, and to reduce abuse of mental health care facilities in Iraq.
Despite these barriers, the needs are too great to ignore and solutions must be created. Medicins San Frontieres/Doctors Without Borders is one organization that has called the state of Iraqi mental healthcare into question, and advocated for more mental health care services to the Iraqi Ministry of Health (MoHI).
“Many Iraqis have been pushed to their absolute limit as decades of conflict and instability has wreaked devastation. Mentally exhausted by their experiences, many struggle to understand what is happening to them. The feelings of isolation and hopelessness are compounded by the taboo associated with mental health issues and the lack of mental healthcare services that people can turn to for help,” said Helen O’Neill, MSF’s head of mission in Iraq.
One solution MSF planned and enacted with the Ministry of Health was the establishment of counseling programs in Iraqi hospitals that provided a non-pharmaceutical treatment for people suffering from depression and anxiety disorders in their post-war lives. Between 2009 and 2012 MSF and the MoHI successfully established three programs: two in Baghdad, and one in Fallujah. MSF made plans to spread the program to Iraqi hospitals in Karbala, Sulaimanyiah, and Kut.
Creative ideas like those of Doctors Without Borders and many other aid organizations are what we must work to make a reality. These programs will assist in reshaping mental health care in Iraq, and improving health care services overall in the nation.