The news service of the United Nations Office of Coordination of Humanitarian Affairs has a report out on psychological trauma among Iraqis. What Iraqis have gone through over the past 40 years rivals the suffering of any other people in the world, but overall, things actually look less bleak in terms of Iraq’s mental health than they did a few years ago.
The mental health survey numbers in the UN account are shocking if you compare them to rates in peaceful countries, but among nations that have experienced war and terrorism (e.g., Lebanon, Rwanda) they are actually relatively low. When I predicted an epidemic of PTSD a few years ago I may have underestimated some important stress buffering factors in the country: Families are close knit, religious faith is widespread, and while addiction is becoming much more prevalent, a significant portion of the population uses no alcohol or drugs at all.
The UN news report mentions the expansion of psychological therapy services in Iraq, which is a major achievement for the Iraqis and was facilitated by the support of the U.S. Substance Abuse and Mental Health Services Administration, the U.K. National Health Service and Royal College of Psychiatry and the International Medical Corps. Another critical factor has been the leadership of Dr. Salih Mahdi Motlab al-Hasnawi, who is a rare creature in the world of health policy: A national Health Minister with a specialization in psychiatry.
As you would expect from his educational background, Dr. Salih has long wanted to expand mental health services, but much of his budget was necessarily devoted to emergency care, given that there have been horrific bombing injuries almost every day for years. That Dr. Salih can prioritize mental health at all with this new initiative is a small but good sign that health officials are getting a little breathing room between critical care incidents.
I hope Dr. Salih is kept on as Health Minister by the new government (presuming it coalesces at all). I am biased by our friendship, but anyone in Iraq would acknowledge that after the prior Health Minister (under whom torture occurred in the health ministry building) Salih brought a non-ideological, non-sectarian fairness and professionalism to the Ministry that was and still is desperately needed.
The most important contributors to mental health in a society are not psychological services, but peace, stability, community, shared values and satisfaction of physical needs. From that perspective, a huge immediate challenge for the future of Iraq’s mental health is improvement in the supply of electricity and potable water throughout the country. The economy is growing rapidly, so the barriers to achieving this are not money but the crippling corruption that plagues every ministry in the government and will be very hard to root out.
To close a fairly grim post with something lighter, the photo above is from the last time I saw Salih. We were in Irbil and I saw that he was wearing a Harvard necktie. So I gave him a Stanford necktie as a gift because I wanted to go home and tell people that things really are getting better in Iraq.