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Al Rashid psychiatric hospital, Baghdad

By Christine Aziz

Iraqi health services are seriously affected by new difficulties resulting from the current occupation of the country. At Baghdad's Al Rashid hospital — the major psychiatric hospital in Iraq — deterioration has taken a rather bleak turn. Since this article was written in July, growing insecurity has unfortunately compelled the ICRC to reduce its presence and its assistance, including to Al Rashid hospital.

The mangled mountain of old hospital beds lying in the neglected gardens of Baghdad's Al Rashid psychiatric hospital are a stark testimony to the looting that took place shortly after the US army entered the city.

According to hospital staff, US forces arrived at the site on 8 April, gouging a hole through the hospital wall to get to a nearby Baath Party facility. Looters arrived shortly afterwards and stole drugs, medical equipment, air conditioners, kitchen supplies, food, fans, mattresses, and even toilets and sinks. Years of medical and psychiatric records were destroyed. Seven hundred of the 1,400 patients ran through the open gates and 400 are still missing. The rest either made their own way back or were returned by Muslim charity organizations and relatives.

Al Rashid hospital, Baghdad, 21 April 2003.
©Ursula Meissner / ICRC


Looting and shock

Seven women were raped during the looting and one woman, aged 28, is now pregnant as a result. Another female patient was shot dead and now lies buried in the hospital grounds.

Al Rashid is the largest hospital in Iraq for the mentally ill. "There are an estimated 250,000 mentally ill people in Iraq and most of them are not getting any treatment at all. They are not cared for here. Psychiatric illness is taboo," says Olaf Rosset, a Norwegian psychiatrist who is psychiatric project manager for the ICRC.

Olaf arrived in Iraq in 2000 to oversee the rehabilitation of Al Rashid's buildings and train local staff. The $3.5 million project had already furnished the hospital with new air conditioners, furniture and beds before the war. A new training programme to bring staff up to date with psychiatric treatments had been introduced, as well as several occupational therapy workshops. But now Olaf has to start all over again. Patients sleep on mattresses, or on the concrete floor and food is cooked in pots over open fires. In the locked courtyard of the men's wards, patients squat along the walls, many of them clearly disturbed, or lie in the shade in a fetal position. Others wander aimlessly around the courtyard in long kaftans.

"This place was in a miserable state when I came here," Olaf says. "There was only one shower in each of the male and female sections, the kitchen smelled terrible. The electricity didn't work and there was no air conditioning."

In the hospital's gutted reception hall, Haji Rasim, 60, waits patiently to see a doctor. For the past month his psychotic grandson Shamikh, 18, who escaped from the hospital during the looting, has terrorized his family. "He terrorizes us with knives and has slashed his mother and his brother," says Jasim. He has returned his grandson to the hospital six times, yet each time Shamick has escaped. "The manager says he can't lock him here because the locks on the doors were taken. We don't sleep at night because of him.He breaks down the door and rampages through the house."

There is very little Al Rashid can do for people like Shamick, except provide them with medication. "We don't have the latest generation of psychotropic medication," Olaf says. "I've had to be very diplomatic in introducing new methods of psychiatry here. Fortunately, during the looting nine out of ten electric shock machines were stolen, and the remaining one doesn't work. The psychiatrists want the ICRC to replace them, but I've told them that the treatment is outdated and harmful."

Nowhere to go

Dr. Bahar Butti has worked at the hospital as a psychiatrist for seven years. "The condition of the patients deteriorated during and after the war. Most patients have been here between five to 20 years. They feel safer here than outside. Many have nowhere else to go. The chronic cases have relapsed because treatment stopped during the bombing. Anti-psychotic drugs to treat schizophrenia and other mental illnesses were stolen," he says. Along with the rest of the hospital staff — 102 nurses and approximately ten psychiatrists — Dr. Butti had to wait several months for his first payment. "We are also suffering psychologically from the war. A lot of people have depression. We are in a state of post-shock," he added.

In a small workshop attached to the women's section, Ines, a thin young woman in a long gown, shows us her drawings. The surreal and colourful sketches give an insight into her world. "She is bipolar. Her family can't cope with her when she becomes manic and hypersexual. In our society it is difficult to deal with and considered shameful," explains occupational therapist Salwa Salih adding, "Ninety per cent of the women and 60 per cent of the men here are schizophrenic."

The ICRC programme at Al Rashid aims to improve drug treatment and training in psychiatric nursing and medicine, as well as provide occupational therapy services. Prior to the war a number of workshops had been set up providing activities for the patients, supervised by trained therapists. These are continuing as best they can and there are plans to provide an occupational therapy facility in the security units. But the future of psychiatric provision in Iraq, Olaf insists, lies in training a new generation of nurses and doctors in the most up to date psychiatric treatments.

Christine Aziz
Christine Aziz is a freelance journalist based in London.

A severe blow to the humanitarian mission

On 27 October a suicide attack on the ICRC headquarters in central Baghdad killed 12 people, including two ICRC Iraqi security guards. Dozens of people were wounded, among them nine ICRC staff — six Iraqis and three expatriates. Before this attack, the ICRC had cut its foreign staff from more than 100 to about 30 after an ICRC technician was shot dead last July. Until this most recent attack the ICRC focused on key activities, such as visiting and monitoring the situation of prisoners of war and civilian internees, as well as emergency medical aid in cooperation with the Iraqi Red Crescent Society. The ICRC has been working continuously in Iraq since 1980 to address the most urgent needs of the population. In light of the prevailing insecurity in Iraq, the ICRC has decided to close its offices in Baghdad and Basra until further notice and to operate from the outside by conducting in and out visits. It will maintain a limited presence in northern Iraq.

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