Baghdad is home to the first ever psychiatric ward in the world. Al-Rhazi (Rhazes), a prominent 9th century Persian polymath chose Baghdad to be home to a hospital that had a dedicated section towards those presenting with mental disorders. Not only were patients with psychiatric disorders given the care and time they deserve in the hospital but as part of the discharge plan for these patients, they were given money to help with the transition outside the hospital. This is said to be the first ever recorded reference to psychiatric aftercare in history.
Treatment for patients included diet changes, medication, occupational therapy, music therapy and many more options. This alongside Al-Rhazi's book of psychiatric illnesses and their differential diagnoses was an incredible step forward in destigmatising mental health disorders. Quite valuably he was said to have always made clear how important it was to show these patients compassion and encouragement… a lesson that of course is still of great significance today.
Despite this pioneering in Iraq's capital… the reality now is much different. Since 2003 (the year of the American invasion of Iraq) more than half of all doctors have left Iraq. In the entire country with a population of 40 million there are less than 50 psychiatrists. In 2008, Iraq had only two functioning psychiatric hospitals across the entire country. In a country where trauma is prevalent these are disheartening figures to see. (1)
To even further show how sparse care is for Iraqis in 2010 it was found that there was one primary care centre per 35,000 population in Iraq, compared with 1 GP per 1,700 population in the UK.(2)
The stigma surrounding mental illness also proves to be a barrier. In a survey carried out in 2010 with over 400 respondents in Iraq over 80% agreed/somewhat agreed that those suffering with mental illness are to ‘blame for [their] own condition’. This paper highlighted many disheartening negative perceptions towards those suffering with mental illness. Improving access alone may not suffice, a cultural shift towards creating less of a ‘shame’ around the topic needs to happen.(2)
Between 2003 and 2011 alone, the total recorded number of violent Iraqi civilian deaths was well above 100,000. But the number of people impacted by these deaths, through injury, losing loved ones, and/or witnessing violent events is many times higher and should not be left out. (3)
There is no question that the need for psychiatric care in Iraq is high, however issues with access to care as well as the ongoing stigmas leaves many to battle their issues alone. Through our practice as medical professionals whether in the UK or Iraq I hope we can make people feel safe enough to seek help from us and provide the highest quality of care possible. If we are in a position to either give this care or have the ability to receive it we can consider ourselves privileged.
Sources and other resources:
Iraq: Impact of War & Violence On Mental Health SIMA webinar (available at thesima.co.uk)