Iraq struggles with mental healthcare crisis

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Hagop recalls the scariest times when battles raged outside the hospital By Natalia Antelava BBC News, Baghdad

A metal frame bed, a plastic cup and change of clothes is all that Hagop owns. He also has a degree in civil engineering from the United States and a life sentence to serve in Iraq - not for the crimes he had committed, but for his illness.

Hagop is one of 1,200 patients who live behind the bars of al-Rashad, Iraq's only mental healthcare institution.

Along the corridors of al-Rashad heavy locks hang on metal doors and all windows are barred.

In the courtyard of one of the wards dozens of men sit on the ground waiting for their lunch. It arrives in big metal bowls, and one by one men get up, scoop rice and lentils onto paper plates, and settle back down on the ground. There are no chairs and no tables.

"Food is terrible and there is not enough," says Kasim, one of the patients.

Kasim used to work as an interpreter for the British troops in Basra. Now he says "life is bad, very bad".

Six years of war in Iraq have virtually destroyed the country's health system, causing thousands of doctors to flee and leaving hospitals without medicine and equipment.

In the country so preoccupied with basic survival, the mentally ill slipped off the priority list.

No visitors

Most of the patients in al-Rashad suffer from chronic schizophrenia, and doctors say that nearly half of them could live at home, but the war and the stigma that their illness carries in Iraq keep them in hospital.

There are no chairs or tables for inmates of the al-Rashad facility

"Neglect is the biggest problem. Only about 10% of patients are sometimes visited by their families, they'll come here but they don't want them back.

"An overwhelming majority don't have anyone at all," says psychologist Saad Joaid.

"My family has kicked me out, society does not accept me, we are in prison here," mutters one of the patients, also called Saad.

Al-Rashad is set right on the edge of Sadr City - one of the city's most dangerous neighbourhoods.

At the height of the insurgency - as the hospital was caught up in the midst of fighting - staff fled, the hospital buildings were looted, and hundreds of patients ran away.

"I stayed," Hagop says. "It was scary, very scary. People from the outside attacked us in our hospital," he remembers.

Some of the patients were found wandering the streets and were brought back by neighbours, but others never returned.

"This was a war zone and we fled the hospital just to save our own skin," says Raghad Sarsam, one of the psychiatrists at al-Rashad.

Dr Sarsam is now back at work, but despite security improvements, for many of his colleagues it is still too dangerous to come to work. The entire hospital is run by only seven doctors.

"We have one skin disease specialist for more than 1,000 patients," says Saad Joaid. "Imagine what it is like trying to care for them."

New approach

Iraqi psychiatrists say the war and violence has taken a real toll on mental health of the entire nation, and that the number of mental disorders is on the rise across the country.

Most patients are confined to bare wards with no activities

"Demand for psychiatric treatment will rise, as the nation digests and comes to terms with what has happened over the last years," says Dr Emad Abdulrazoy, National Adviser for Mental Health at the Ministry of Health.

Dr Abdulrazoy's job is to set up a new programme, which will aim to create psychiatric care centres in hospitals across the country.

But this could take years, especially since the whole of Iraq, with its population of 30 million, has only 70 psychiatrists.

"These days it's not the most appealing profession. Young people would rather go into surgery or dentistry, where it's easier to make money," says Dr Abdulrazoy.

But even if and when they are set up, the new centres are unlikely to make much difference to the patients of al-Rashad.

"The problem is that most of them have been here for so long that they are beyond the point of recovery," says Dr Sarsem.

For now, the staff at al-Rashad are preoccupied with trying to meet basic needs, like a lack of medicine, equipment, food and they are also in a desperate need for a rehabilitation programme.

There is a tiny centre at al-Rashad, which offers art and music therapy classes.

But the resources are so scarce that the rehabilitation programme can accommodate fewer than 100 patients.

More than 1,000 others never get to leave their wards.

"Our hospital is a good hospital, but life is hard" Hagop says.

Hagop's illness is now in remission and his doctor says he could leave now if he had a home to go back to.

He does not, and al-Rashad is where he will be staying.