Baghdad, 2011 — The flats in Sadr City are lined up close together. This suburb is home to some three million poor Shiites. Swinging tires and rusty car parts litter the sidewalks. Green flags wave from electricity poles and shop fronts. Blast walls are littered with posters of the Shiite cleric Muqtada al-Sadr. If women dare to take to the streets, they walk in a hurry, bent over and covered in black from head to toe.
On Sunday morning, the beginning of the Iraqi workweek, a woman in the admissions room of the psychological clinic at Imam Ali Hospital laments that in the night she was overtaken by sadness and headaches. She had been listening to the recording of a sermon about the death of Imam Hussein, the grandson of the prophet Muhammad who was slaughtered in 680, sparking the rift between Sunni and Shia. The woman is in her fifties, completely dressed in black, down to the black stockings below her sandals. The sermon reminds her of the death of her mother and she feels so lonely. Her therapist, Samir, suggests they find useful activities for her to do daily in the coming weeks. He guides her in a relaxation technique: “Say to yourself as you slowly exhale, ‘Thank God, God is superior to all mistakes.’”
Officially, psychiatric diseases hardly exist in Iraq. According to the Mental Health Survey conducted by the World Health Organization from 2006 to 2007, less than four percent of Iraqis struggle with post-traumatic stress disorder, a number that is certainly a severe undercount, considering almost half the population has experienced a war trauma such as witnessing murder, a shooting or a bomb blast. Fewer than ten percent received any kind of mental health treatment at all. “It’s ignorance,” says Dr. Haitham Abdalrazak, who leads the psychological clinic at Imam Ali Hospital. Many Iraqis consider a psychiatric illness something to be ashamed of. “Psychological problems are seen in our faith as a visitation by the devil. That’s the stigma that we must overcome, so that people can get the help they need.”
Dr. Haitham (who is generally addressed by his first name, following Iraqi convention), is in his mid-forties, with a receding hairline and a square face that doesn’t show much emotion, introduced Western-style counseling in Sadr City in 2009. With the help of Doctors without Borders he founded a structured therapy practice with half-hour sessions. The treatments by Dr. Haitham and his team are free. Appreciating a scientific approach, he has his patients fill out a form before and after treatment, evaluating their own performance on a scale from one to ten. On average patients score four points higher on social and occupational functioning after their treatment than before.
Haitham is the second of nine children, the son of an illiterate mother and a father who worked as a civil servant. At seventeen he plucked The Occult by Colin Wilson from his father’s bookcase. It proved the beginning of a lifelong fascination with the act of making his mind stronger. His high marks in school gave him entry to the most desirable university program, medicine, and in that he chose the least desirable specialization: psychiatry. Few voluntarily chose it, but Haitham was genuinely interested in people.
He completed his Ph.D on finding an organic cause of why patients with diabetes are more likely to suffer from depression. But before he finished, the U.S. invaded Iraq. “Every human being wants to live in a democracy, but I had never thought that Iraq would become such a mess,” he says. “If you were to ask me now, I would say it would have been better if it hadn’t happened. Not because I am such a fan of Saddam, but because there have been so many people murdered, so many have lost their way – there is so much misery here.”
He still believes in a new Iraq, despite the hopelessness he encounters. “People say about the bomb explosions, ‘Ah, we are used to it,’ or “God decides when I will die.’ That is really learnt helplessness, that you don’t even try to get away!” But he still believes there are others like him, who want to live in a peaceful Iraq. “Together we can perhaps achieve something. If we give up, we will never succeed.”
Dr. Haitham is called into Room 3, where a man is sitting with his six-year-old son Mehdi, who refuses to go to school. “Hey Mehdi, do you like soccer?” Dr. Haitham asks. Mehdi turns his entire body towards the back of the chair and keeps quiet. His father pulls his arm. “No, let him be,” Dr. Haitham says and tries again. Mehdi doesn’t respond.
“He likes cartoons and video games,” the father says awkwardly. “Doctor, none of his brothers are like this.”
“Did something happen at his birth? Did you notice he was different?”
Nothing, Mehdi’s father assures him. Every time Mehdi was bullied at school, he ran out of the class to his mother who taught at the same school, but she always brought him back. Now he refuses to go to school at all.
“If Mehdi does something wrong at home,” Dr. Haitham asks, “does he then also run to his mother?”
“Yes, if I want to beat him, he also runs to his mother.”
“And does your wife let you beat him?”
Domestic violence is common in Sadr City, the violence from outside vented at home on the women and children. Some men refuse to allow their wife or children to get psychological help, something that keeps Haitham awake at night.
The doctor asks a few more questions and then says firmly: “Parents are responsible for building the child’s character.” The man nods. “You do that by doing things together or by talking. If you punish him, do not beat him. Instead take him aside and explain what he’s done wrong.” He writes out a note ordering an IQ test.
Mehdi’s father again asks: “What do you think is wrong with my son, doctor?”
“I think there is nothing wrong with his mind. The problem is how you and your wife react to him. And fortunately that is something we can do something about.”
Of all the patients who come in that Sunday, only one bears the visible effects of violence: a twenty-five-year-old man with scratches on his arms. His leg is in a cast with pins sticking out. In 2005 he went to get a sandwich, when an American convoy drove by and hit a roadside bomb. His lower leg was shattered. “I have tried to end my life three times, but each time it was unsuccessful,” the young man laments. “I feel useless. I cannot work and I will never be able to walk normally.”
The psychiatrist asks questions, summarizes what the young man says. It often seems that this is all Dr. Haitham is doing – but in a country with so much suffering, very few are still able to really listen.
Back in 2007, Dr. Haitham’s father-in-law was abducted and released after a ransom was paid. That same year Haitham was sent to Imam Ali hospital in Sadr City, where a sectarian war was raging. During the night, at checkpoints held by Shia militias, Sunni men were kidnapped or shot point-blank, as were Shia men in Sunni neighborhoods. Dr. Haitham, a Sunni, couldn’t possibly go to Sadr City. But he refused to tell the district head why. “I thought if I tell him that I am Sunni, he will accuse me of making a distinction.” He tried to find work in the Kurdish north of Iraq, but that proved to be unsuccessful, so he finally accepted his fate.
Haitham was extremely nervous the first time he stepped on a bus to Sadr City. “At each checkpoint I thought: This is it, then,” he recalls. But as the days went on, he began to feel more at ease. In 2008, when Doctors Without Borders asked him to start group therapy, he felt confident enough to agree, certain his colleagues and patients would never find out he is Sunni.
His own faith only came to him when he was twenty-nine, at the annual commemoration of the Iran-Iraq War in 1998. He was sitting at a bus stop when a man asked if he could sit next to him. The station was empty, but Haitham nodded and moved. The bus came, the man left. He heard a loud noise. Someone had fired into the air to celebrate. As the bullet came down again, it fell straight through the roof, landing exactly on the spot where he had been sitting. He has always kept the bullet.
Now, he feels he is doing something needed. In 2011, as the U.S. Army prepares to withdraw from Iraq, he believes in a brighter future. Above all, he is keen to make Iraq psychologically literate.
2012 is Dr. Haitham’s year of glory. Together with Doctors Without Borders he sets up counseling departments in Baghdad, in the Sunni city of Fallujah in the west, in the Shiite cities of Najaf and Karbala in the south, and in the Kurdish city Suleymaniah in the north. He develops a program for telephone therapy. His team in Sadr City reaches some 2,000 Iraqis.
But at the end of 2012 a new colleague arrives. The man is completing his Ph.D in order to become the assistant to the director of healthcare in their district. He is a member of the political party of Muqtada al-Sadr and has a strong network in Sadr City. Meanwhile, the country is once again falling apart along ethnic lines.
Dr. Haitham says the man is not interested in psychotherapy, but rather in the money he believes Dr. Haitham receives from Doctors Without Borders – the man doesn’t know that the organization pays the cooperating psychiatrists only a few hundred dollars. “He came between me and my work,” Dr. Haitham mutters stubbornly.
Haitham loses his authority in the closed community he had become a part of. He is transferred to another hospital. A doctor with no experience in counseling takes his place. When he goes to complain to the director of healthcare, nothing happens. “I realized that I am Sunni, and that I am in their eyes suspect because I worked with foreigners,” says Haitham. Eventually, his project is halted altogether. Despondent, he heads for Kurdistan, the autonomous region in the north. “I had often thought about leaving,” says Dr. Haitham, “but when I finally did, it felt like giving up.”
Zakho, Kurdistan, 2015 — A couple in their mid-twenties shuffle into the treatment room of Dr. Haitham in the small border town of Zakho, in northern Iraq. The couple are refugees; he has a thick, burnt upper lip, she wears a shapeless black sweater and a scarf wrapped around her mouth. The doctor invites her to sit down in the chair on the other side of his small desk in the otherwise empty room. She suffers from a reactive depression. She doesn’t sleep, won’t eat. Tests show she has severe anaemia. He listens to her thoughtfully. He carefully weighs his words, speaking with a psychiatrist’s distance to emotions. He softly says to her: “You’re safe here.”
He writes out a prescription, in English, then his signature, in Arabic, from right to left. The young woman takes off her scarf to dab her eyes, but when there are no tears, her face contorts with rage.
Dr. Haitham is now the only psychiatrist in Zakho. A few months after his arrival, ISIS conquers the Sinjar area, home to thousands of Yazidis, ethnic Kurds who ISIS sees as devil worshippers. Tens of thousands of Yazidis fled to the top of a mountain, surrounded by militants, without water and in the blazing sun. Hundreds of girls are abducted and used as sex slaves. Eventually some 100,000 refugees reach the safety of Zakho, in the autonomous Kurdish region of Iraq. Only a few find the office of Dr. Haitham.
There are long lines of refugees in the hallways of the new hospital in Zakho – but not in front of his room. Only the most distressed cases make it here, such as women who do not know what has happened to their loved ones and, having no way to express their psychological trauma, become paralyzed or suffer epileptic seizures.
Dr. Haitham no longer has that self-assured fatherly glow about him. He has not been given a residency permit – the Kurds see in every Sunni Arab a potential terrorist. He can’t even visit his parents in another city, and he is thinking about leaving Iraq. “My children can’t go to school, because the schools are filled with refugees,” he says. From his desk he stares out over the parking lot to the mountains. Then he says softly, nearly apologetically: “I cannot give what I am missing myself. I am but a human being.”
But his despondency does not last long. He goes to the refugee camps and finds out that the women here can’t reach the hospital because it’s too far out. Together with a local aid organization, he has now made it his mission to train volunteers to provide psychological counseling in the refugee camps. In a war-torn land still desperately lacking in mental health treatment, this doctor is determined to make an impact.
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