Optimism about the mental health of the Iraqi people

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.

Author: Keith Humphreys

Keith Humphreys is the Esther Ting Memorial Professor of Psychiatry at Stanford University and an Honorary Professor of Psychiatry at Kings College London. His research, teaching and writing have focused on addictive disorders, self-help organizations (e.g., breast cancer support groups, Alcoholics Anonymous), evaluation research methods, and public policy related to health care, mental illness, veterans, drugs, crime and correctional systems. Professor Humphreys' over 300 scholarly articles, monographs and books have been cited over thirteen thousand times by scientific colleagues. He is a regular contributor to Washington Post and has also written for the New York Times, Wall Street Journal, Washington Monthly, San Francisco Chronicle, The Guardian (UK), The Telegraph (UK), Times Higher Education (UK), Crossbow (UK) and other media outlets.

One thought on “Optimism about the mental health of the Iraqi people”

  1. KH: Heartening news! But: "… 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.."

    Still not fixed after seven years! Compare Correlli Barnett's account of immediate postwar Germany in 1946, after a level of destruction incomparably greater – remember this was well before the Marshall Plan, so the occupiers didn't have a huge budget, they just put Germans to work. OK, no insurgency, but that didn't really get going in Iraq in the first year. Excuse the long but necessary quotation:

    "For the sake of simplicity, I will concentrate on the record of the British zone of Germany, which in any case contained the densest concentration of industry and population. The Americans and the French in their own zones followed broadly similar policies, with broadly comparable results [para in footnote]….

    The first published report by the Control Commission for Germany (British Element) in June 1946 describes what had already been accomplished in twelve months, both in regard to physical reconstruction and to social and political transformation. Almost the entire route-mileage of railway was now repaired and in operation. Eight hundred rail bridges had been repaired or rebuilt, including two semi-permanent ones over the Rhine. About a third of the 1500 demolished road bridges had been reconstructed, while the number of road transport workshops had been increased from 744 in July 1945 to nearly 4,000. All main waterways were now open, so that monthly loads carried by inland water transport had risen from less than 40,000 tons in June 1945 to just under two million in June 1946. Under direction of the Royal Navy, German ports too had been cleared of obstructions and rendered capable of dealing with current demand. Output per man-shift of coal, the basic energy source for transport and industry had doubled over the year. And during the six-month period September 1945 – March 1946 over half a million dwellings received emergency repairs, partly with the aid of the Royal Engineers. Internal postal services were back to normal, while the public telegraph system was now carrying 50 per cent more traffic than in 1938.

    Just as impressive were the achievements of the occupation regime in health and welfare, even in the face of acute malnourishment because of desperate Europe-wide shortages of food and the highly insanitary conditions resulting from bomb damage to water and sewage systems. Some 75 per cent of the population had been inoculated against typhoid and typhus. Children and adolescents had been immunised against diphtheria. The infant mortality rate had been halved. The number of hospital beds had been increased to 275,000. …"

    The datum about the telegraph system carrying more traffio than in 1938 is significant; totalitarian states don't like communication. I remember in 1990 Berlin seeing new phone cables being laid near the old Wall – you could see the old frayed cable, possibly dating back to the 1920s, carrying a few dozen lines. What was replacing it was a sheaf of eight or so cable tubes, in each of which you could put several fibre-optic cables, each of which would carry dozens of fibres, each of which could carry hundreds of times the capacity of the old cable. An increase of at least four orders of magnitude.

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