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Peace has a chance in Iraq, but mental scars remain

The absence of community-based mental healthcare means the only care available is in psychiatric institutions, which have been linked to gross human rights violations.

Eighteen-year-old Rehat Hama-Aziz was a clarinet player from Halabja, in Iraq's Kurdistan region. Last December, he was awarded first place as a solo musician in the fifth Annual Rwanga Awards. The very next day, his father notified authorities that he feared his son was having suicidal thoughts.
The same day, Rehat attended his class at the Slemani Fine Art Institute, came home and took his own life. According to family members, this was after he gathered his musical instruments and performed in his room one last time.
His death brought to light, once again, the severity of the region's mental health crisis. Mental health is destroying Iraq's population - most importantly, the younger generation that is its future.
The incident also revealed just how unprepared the authorities are to offer support. The rate of those affected by mental illness is still rising, with almost 20% of Iraq's population now suffering. They are deprived of necessary treatment and care due to low awareness and understanding, too few mental health professionals, and a massive social stigma.
Meanwhile, the causes of mental illness are scarcely investigated or researched, causing alarm about the future of mental wellness in Iraq.
The war has left immense scars, and NGOs are now focusing on its emotional and psychological impact. One such organisation, Médecins Sans Frontières (MSF), brings teams of qualified doctors, psychologists and counsellors who provide vital care and support for moderate and severe cases - including post-traumatic stress syndrome, depression, schizophrenia and severe anxiety.
Iraq's constitution states that 'every individual has the right to enjoy life, security and liberty.' The state must act when life is endangered. The inadequate care and treatment being provided to the country's citizens, is thus in breach of Article 15. Inadequate mental health services mean that one in five Iraqis are unable to exercise this basic right.
Given Iraq's turbulent and traumatic history, it is essential that mental health issues receive the attention and funding they deserve. Little is known regarding the epidemiology of suicides in Iraq, on account of the lack of institutions to measure, examine or intervene.
Factors that can cause mental illness include childhood abuse, trauma, social isolation, experiencing discrimination or stigma, poverty, bereavement, severe or long-term stress and fear. In 2018, the Iraqi National Study of Suicide conducted an analysis in 13 of Iraq's 18 provinces, examining data from legal investigations: police, family and post-mortem reports. It specifically studied cases where the cause of death was uncertain.
It found the rate of suicide per 100,000 members of the population was 1.09 (1.21 for males, 0.97 for females) in 2015, and 1.31 (1.54 for males, 1.07 for females) in 2016, indicating a rapid increase in just one year.
The most common methods of suicide included hanging (41%), the use of firearms (31.4%) and self-burning (19.2%). In 24.1% of the cases, the suicide was associated with psychiatric disorders, with a major cause being depression (53.9%). Other causes include psychological trauma (15.5%), financial problems (12.4%) and childhood abuse (2.2%). One of the country's most widely documented challenges has been internal displacement. Poor living conditions and finances have an impact on psychology as well.
The battle against Daesh, after years of conflict, has increased fears that another war may soon arrive and that stability is not possible in this region. MSF has reported on how internally displaced people are isolated, angry, anxious and stressed, with many children showing signs of aggressive behaviour, incontinence and anxiety.
Based on the scarce research available, it is clear that suicide and mental illness is worryingly common in young people in the country. Iraq risks losing its future leaders and inspirational figures to an epidemic it has done little to address. In Kurdistan, where Rehat was from, there are only four government mental-health hospitals - one each in Erbil and Duhok, and two in Slemani. The burden of mental healthcare thus falls on NGOs like MSF.
The absence of community-based mental healthcare means the only care available is in psychiatric institutions, which have been linked to gross human rights violations, including inhumane treatment and degrading living conditions.
In 2010, public opinion surveys were conducted by Iraqi Ministry of Health and the International Medical Corps, exploring how mental health is perceived within the country. The results were startling - approximately 60% of respondents agreed that "mental illness is caused by brain disease," while 65% affirmed that psychological problems originated from "personal weakness". A full 80% said that individuals with mental health problems are responsible for their own condition.
On a social level, the stigma around mental health speeds the process of sufferers turning to suicide or self-harm. On a public level, this stigma may help explain why the issue has been dealt with so poorly by the government.
Bamo Nouri is an investigative journalist, researcher and academic who has a PhD in International Politics. - Thewire.in