The Recovery Road to a Sane Nation

This article was originally written for and published by Awat Newspaper.

In my last article The Suicidal Truth I spoke about the problem of Suicide in Kurdistan, this article will focus more broadly on general mental health and the issues surrounding it within Kurdistan.

According to the World Health Organisation (WHO) 420 million people are affected by mental, neurological and behavioral problems worldwide and 873,000 people commit suicide every year. Mental illnesses are common in all countries and cultures and cause severe suffering. People with mental health problems are often subject to low quality of life, social isolation and increased mortality. They belong to one of the world’s most neglected groups in the world and their situation may be even worse if they belong to an ethnic minority as well. In the case of the Kurdish people this is a major problem as they also belong to one of the most neglected and oppressed ethnic minorities around the world. Traumatic life events and losses are two common phenomena for the Kurds.

Armed conflicts and war cause significant psychological and social suffering to populations. These psychological and social impacts clearly undermine long-term mental health and the psycho-social well-being of the entire population. These impacts also threaten peace and reconstruction. South Kurdistan has gone through a period of insecurity, violence, destruction and displacement of the population. Furthermore, the day-to-day life for the majority of the population of Kurdistan has been associated with multiple deficiencies in the supply of basic necessities like electricity, water, sanitation, food, employment, and access to health services, beside the continuous threats of violence which can be the causes of stress to individuals and families.

Although no specific information and statistics can be found on mental health in South Kurdistan, a few studies have been conducted on Iraq including the Kurdistan region under its occupation. Assessment of the mental health system was completed in 2005 using the WHO-Assessment Instrument for Mental Health system (WHO-AIMS) format. This has been a significant achievement, as it covers the current mental health situation in six different areas: policy, human resources, research, integration of mental health with primary health care, and inter-sectoral involvement in mental health and public awareness. Since the fall of the previous regime, there have been fundamental changes in the mental health system.

The percentage of mental health training for medical doctors corresponds to 3% of the total curricula; for nurses it makes up to 5%. Only physicians can prescribe drugs, and the prescription of psychotropic drugs is the prerogative of the psychiatrist. In terms of human resources recent data shows that in the Kurdistan region there are 17 general psychiatrists, 2 psychiatric practitioners, 4 child and adolescent psychiatrists, 91 psychiatric nurses, 4 psychologist, 15 social workers and 2 psychotherapists (2005).

In 2010 the then Minster of Health Mr Tahir Hawrami called for the view of the bill for a mental health act in Kurdistan. He stated that “90% of the Kurdish people” had suffered through terrible ordeals and atrocities such as the Anfal campaign over the last century. Although the minster’s words fell on deaf ears his cry was not without strong evidential basis. In the mental health survey conducted by the World Health Organisation (2005) in Iraq in partnership with the Ministries of health of both Iraq and Kurdistan it was demonstrated that 8.97% of all effective disorders in Kurdistan had a life time prevalence and 15.85% of any anxiety disorders. The discrimination and stigma associated with Mental illness exists around the world, but in a developing country where a deep presence of ignorance around mental illness exists, the discrimination and stigma is far worse. Yet the need for improvement far out ways any other health condition and its prevalence is far greater than other countries around the world. This is due to the duration of unstable and stressful conditions (eight years of war with Iran, Iraq’s invasion of Kuwait, Gulf war in 1991, 13 years of economic sanctions, and invasion and regime change in 2003 followed by years of extreme insecurity) both Iraq and Kurdistan, as a result, are in an extremely complex psycho-social situation. Mental illness can also lead to a range of other illnesses if left untreated and therefore cause extra, unnecessary burden on the already struggling health system.

As previously observed, the occurrence of mental disorders in the community might have been underestimated. Mental illness is still highly stigmatized and symptoms of such illness might be embarrassing and likely to be denied. (Gureje et al, 2006). Declarations of anonymity and confidentiality might also have less persuasive power in motivating complete reporting of the symptoms (Karam et al, 2006, Gureje et al, 2006). There are a number of cultural factors that are important in understanding the prevalence and pattern of mental disorders in Kurdistan as well, the high stigma associated with mental disorders is a major one. Others include, the long conflict period could have contributed to the development of acceptance of some of the conflict experiences as “normal” and the role of available social support from family and the community, and the protective role of religion.

Kurdistan faces a host of public heath challenges, addressing these challenges through different means from reforming of public health bills through to the education and training of public health professionals will pave the path of improvement for Kurdistan’s mental illness crisis. Important changes have already taken place with the WHO organizing resource materials for psychological first aid by school teachers and community level workers; existing manual of mental health for medical officers has been revised with a special emphasis on emergency- related mental health and psycho-social care. Training programs have been conducted at the governorate level to train doctors and health workers in essential mental health care. However, the mentality of the society around the notion of mental health illnesses must be eradicated before any of these changes can take full effect. The most effective way of bringing about a mental change in the society is through education and patience. It will take generations before there is a complete and common understanding of mental health in Kurdistan. but it’s not impossible.

I must admit when I set out to investigate the issue of mental health I was expecting horrendous results with absolutely no attention given to the mental health section in Kurdistan. However, it seems with the help of the World Health Organisation, Mental Health is on the priority list of health illnesses to tackle, especially with education to drown the discrimination and stigma which largely exists around it. Kurdistan is well on its way to drastically improve the mental well being of its nation.