NEWS
Mental health a major priority in reconstruction of Iraq's health system
Fiona Fleck
Geneva
When outgoing interim Iraqi Health Minister, Dr Khudair Abbas, embarked on the reconstruction of Iraq's collapsed health system last summer, he was shocked to find that there were only two psychiatric hospitals for a country of 24 million people.
According to Abbas, patients with mental health problems had been kept under prison-like conditions and many escaped when their institutions were looted and vandalized last year. Inhumane treatment of patients was symptomatic of Saddam Hussein's dictatorship which tortured and murdered thousands of citizens, said Abbas.
"[It is] not only the trauma of the past. We have to address the effect of the current conflict on the people," said Dr R. Srinivasa Murthy from WHO's Regional Office for the Eastern Mediterranean, who is responsible for mental health in the region.
In July 2003, WHO hosted an expert consultation in Cairo to discuss the mental health and rehabilitation of psychiatric services in post-conflict and complex emergencies in a number of countries, including Iraq. They found that these populations were traumatized by acute and chronic stress.
"Most of the population needs support to master the situation," Dr Murthy said, referring to countries like Iraq.
When Abbas became health minister in September 2003 he drafted a health needs assessment with the help of WHO and other international experts, including James K Haveman, a public administrator from the US, appointed by the Coalition Provisional Authority (CPA) to advise him. They singled out mental health, alongside infectious diseases and cancer treatment, as the three top priorities.
In February, Dr Abbas appointed Iraqi-born psychiatrist Sabah Sadik, who had been in exile in the UK for 25 years, as Iraq's National Advisor for mental health. An Iraqi Mental Health Council representing a wide range of disciplines was then formed and a draft Mental Health Act has been submitted to Iraq's Governing Council.
In May, 16 psychiatrists from across Iraq attended a WHO training workshop in Beirut, Lebanon, to review Iraq's mental health needs, update their own knowledge and discuss the proposed mental health reforms. The same month, the Iraqi health ministry prepared a one-year mental health plan financed by a US$ 6 million donation from Japan to focus on mental health services, training new staff and rebuilding a mental health infrastructure.
Iraqi psychiatrists have received training in Jordan, Kuwait, the US and the UK. In addition, the US Substance Abuse and Mental Health Services Administration has sent over mental health professionals to Iraq to help train local staff.
Sadik's key focus is to create a community-based mental health system that is integrated into some 1200 primary health-care centres now operating across the country. That means creating psychiatric departments within many Iraqi hospitals, rather than the previous system under which patients were isolated from society.
Abbas said that under the old regime, psychiatry and mental healthcare were neglected, plagued by under-staffing and lack of medicines and equipment. Counselling and psychological support services for people suffering post-traumatic stress syndrome and depression were largely unavailable. To address this, a group of Iraqis recently attended psychosocial workshops in Amman, Jordan, to train as counsellors to work with children in schools.
Under the new mental health system, all hospitals will aim to provide counselling to patients with serious or terminal illnesses such as cancer. Some hospitals are already offering such support. Noful Daoud hospital in Baghdad where torture victims such as army deserters who had their ears amputated undergo cosmetic surgery, also receive counselling to help them recover from their experiences.
Abbas's successor the former education minister, Dr Ala Alwan, will take charge of the health ministry which unlike most other Iraqi Government ministries was returned to Iraqi hands in May 2004.
When he takes over on 30 June Alwan, who was previously WHO Representative in Amman, Jordan, faces several challenges including spiraling reconstruction costs due to growing security concerns in the country. Progress in reconstructing the health service has been slow as Iraq's hospitals and primary health-care centres suffer from power cuts and unreliable clean water supplies, and the ministry has also had to learn to respond to emergencies, said Abbas.
Multiple explosions in Karbala and Baghdad in March that killed 58 and injured more than 100 caught the fledgling health system totally unprepared and prompted the health ministry to ask WHO to help set up a system which would lead to effective and predictable responses to health crises throughout the country. 