5. Memorandum submitted by Centre
for Psychosocial Health—Iraq (CPHI)
Psychological and social consequences of violence
and wars, whether experienced by children or adults, and their
profound adverse impact on victims and their families are well
documented by research.
Individuals may be traumatized by a single event,
such as an physical or sexual assault and torture or by experiences
that occur over a period of time, such as wars. Whatever the circumstances,
psychological trauma affects people's ways of thinking, their
memories and emotional strategies for coping and adapting. Moreover
survivors often blame themselves, and have difficulty with trust
and intimacy. Indeed, psychosocial recovery is recognized as a
very important focus for relief efforts, along with repairing
homes and rebuilding the infrastructure.
The World Health Organisation (WHO) addressed
this important need as urgent as well as medium and long term.
A recent document published in 2003 "Mental Health in Emergencies—Mental
and Social Aspects of Health Population Exposed to Extreme stressors",
highlighted such immediate and urgent need.
Within this context post—traumatic stress
disorder is debilitating, in which people with PTSD have persistent
frightening thoughts, and memories of their ordeal. The victims
repeatedly relive the traumatic experience in the form of nightmares
and disturbing recollections during the day. They may also experience
sleep problems, depression, and feelings of detachment or numbness.
They may lose interest in things they used to enjoy and have trouble
feeling affectionate. They may feel irritable, more aggressive
than before, or even violent. Seeing things that remind them of
the incident may be very distressing, which could lead them to
avoid certain places or situations that bring back those memories.
Anniversaries of the event are often difficult.
Post-trauma suffering can occur at any age,
including childhood. The disorder can be accompanied by anxiety,
depression, substance abuse. Symptoms may be mild or severe—people
may become easily irritated or have violent outbursts. In severe
cases victims may have trouble working or socialising. In general,
the symptoms seem to be worse if the event that triggered them
was initiated by a human perpetrator—such is the case in
Iraq—as opposed to natural disasters.
Ordinary events can serve as reminders of the
trauma and trigger flashbacks or intrusive images. A flashback
may make the person lose touch with reality and re-enact the event
for a period of seconds or hours or, very rarely, days. A person
having a flashback in the form of images, sounds, smells, or feelings,
usually believes that the traumatic event is happening all over
again in that instant. Thus, a traumatic event or situation creates
psychological trauma when it overwhelms the individual's perceived
ability to cope, and leaves that person fearing death, annihilation,
mutilation, or psychosis. The individual feels emotionally, cognitively,
and physically overwhelmed.
WHY IRAQ
IS A
UNIQUE SITUATION
Unlike many other countries, where the populations
suffered traumatic experiences due to man made violent events,
Iraqi citizens have lived through different forms and extending
over a period of more than three decades . These include:
— political violence—Massive
in scale perpetrated and controlled by the state , severe, repeated,
prolonged and unpredictable. Also multiple and life threatening
— Internal conflicts due to the declared
and undeclared war against ethnic , religious and political affiliations.
This included the use of chemical weapons against the Kurds and
people who joined the uprising in 1991 and the infal campaign
— Human rights abuses—kidnapping,
torture, rape etc.
— Twelve years of harsh and devastating
economic sanctions
In Iraq , the psychosocial impact on the citizen
are most severe because the trauma is
1. Human caused
2. Repeated
3. Unpredictable
4. Multifaceted
5. Sadistic
Indeed even if the regime or the which is responsible
for the continuity of these traumatic event is over, the person's
reaction to it is not. The intrusion of the past into the present
is one of the main problems confronting the Iraqi survivors. Often
referred to as re-experiencing, this is the key to many
of the psychological symptoms and psychiatric disorders that result
from traumatic experiences. Therefore, even with a hugely successful
political, economic and cultural rebuilding and restructuring
of Iraq, The process will be undermined by the impact of the psychological
and emotional consequences on the individuals.
The survivors of repetitive trauma are likely
to instinctively continue to use the same self-protective coping
strategies that they employed to shield themselves from emotional
harm during the pat regime. Hypervigilance, dissociation, avoidance
and numbing will continue to be an obstacle for the citizens
to adapt in the new Iraq.
Furthermore, this direct work with individuals
will provide a bedrock for a future national policy and strategy
for the Iraqi society to heal it self from the wounds and sadism
of the old regime and will promote and raise awareness for the
need for reconciliation and tolerance and not revenge or reattribution.
To achieve a process of transformation into
a healthy democratic Iraqi society will require intensive and
focused work on community as well as on individual level. There
is a legitimate concern and fear in Iraq from the explosions of
rage and revenge which is already a daily experience. Moreover,
for many victims legitimately want to see their abusers punished.
They find it obscene to see their torturers can enjoy life untroubled
by the wreckage they have caused let alone being seen to occupy
senior positions, and the thought of retribution brings some bitter
satisfaction. However, for many others, they care more about what
might be done to help their own recovery.
First most victims want decisive action taken
to ensure their protection and safety. They also want assurances
that the offender is exposed and no longer be permitted to abuse
other people or to profit from his crimes. They often want some
material restitution for the harm done to them. They want acknowledgment
that what happened to them was wrong and the burden of guilt and
shame lifted from their shoulders and recognition for their own
endurance and dignity.
ADDRESSING THESE
NEEDS IS
ALSO AN
URGENT HUMANITARIAN
ISSUE
What needs to be done now ?
The scene of men and women with enduring and
severe mental health problems wandering aimlessly in the garden
of the largest and oldest psychiatric facility in Iraq was overshadowed
by the rapidly folding events of the third gulf war and the tragedies
of the "day after" is a reminder what need to be done
now .Of the more then 1,000 residents only few hundreds left with
no food , medicines or clothing's or staff to care for them.
— Provide an urgent aid to the residents
of psychiatric institutions in Iraq and to ensure that services
are restored including staffing and specialist medication.
— Establish emergency centers within
the existing services to receive acute mental health emergencies,
the majority of whom are women, adolescents and elderly Ensure
availability of essential psychotropic medications. Many persons
with urgent psychiatric complaints will have pre-existing psychiatric
disorders and sudden discontinuation of medication needs to be
avoided. In addition, some persons will seek treatment because
of mental health problems due to exposure to extreme stressors.
— Establish and disseminate an ongoing
reliable flow of credible, sympathetic and empathic information
on how to get emergency psychosocial help specially victims of
physical or sexual assaults and on normal stress reactions and
how to cope and seek help and the expectation for natural recovery.
This will also include outreach psychosocial support.
— Liaison with humanitarian, relief
Organisations & NGOs on the availability of emergency psychosocial
services and training on psychological first aid (ie, listen,
convey compassion, assess needs, ensure basic physical needs are
met, do not force talking, mobilize and encourage family or social
network support y and protect from further harm.
— Embark on medium and long term planning
in collaboration with Iraqi mental health services including need
assessment and support the restructuring of mental health services
in line with the policy of the government and plan and support
on the additional services to meet the new psychosocial need due
to oppression and war.
— Engage and support the process of
Iraqi society healing and national reconciliation to end the legacy
of the old regime.
CONCLUSION
We hope that the evidence in this document will
help the session to consider the importance of this important
urgent humanitarian need, which tend to be overlooked.
CPHI will be ready to provide more detailed
programs if this required.
Chairman: Dr Majid AL-Yassiri, MBChB,DPM,MRCPsych
Consultant Psychiatrist
Board Members :
Secretary : Dr Shetha Besarani
Accountant: Mr Ahmed Khdier
Director of Training : Ms Sherbana Sacoor
Director of psychosocial health Promotion :
Ms Faten Barakat
Director of Research : Dr Ali AlRubai
Director ( Liaison with interim health authority
in Iraq) Dr Badea Alkhalaf
Dr Mohammed Ihssan Sulaivani. Minster of human
rights, Arbil-Kurdistan
Dr Laith Aldelaima—Advisor on primary
care
Dr Faisal Al-Durah—Adviser on public health
15 May 2003
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