Enab Baladi – Hebaa Shehadah 

Maysa has completed her work at the school located in the town of Atme in the northern countryside of Idlib and walked her long route home from school as usual. Still, that afternoon, on 2 September, she brought with her something she was not accustomed to buying as if she was maniacally preoccupied with the idea of ending her life. 

The 33-year-old Maysa committed suicide by consuming rodenticides, colloquially known as rat poison, after suffering years of domestic violence that led to removing her three children from her by her husband. 

  Maysa’s suicide shocked her family, friends, and acquaintances because she was well known as the “pious believer” as they described her, even though they all knew about her suffering while bearing the scars of her physical and psychological pain in plain sight.

Incidents of domestic violence are frequent around the world. According to the World Health Organisation (WHO) data, about 1 in 3 women experienced either physical and/or sexual intimate partner violence or non-partner sexual violence in their lifetime.

However, people of northern Syria suffer more than one type of hostilities. They face unparalleled economic pressures, severe poverty, and security concerns as the war has entered its tenth year. Besides, hundreds of thousands of people have been repeatedly displaced and denied their fundamental rights to stability and security. 

 Maysa’s suicide was not the first case in northwestern Syria, nor the last, with the spread of news of the suicides and suicide attempts in a region which houses more than four million people gathered from all parts of Syria.

Increasing suicide cases are not matched by an increase in psychological support

Suicide cases in northwestern Syria have increased since the beginning of this year, by 38% between the first and second quarter of the year, according to the statistics of the Office for the Coordination of Humanitarian Affairs (OCHA) issued on 21 August.

It is worth mentioning that 20 health organizations, via 157 health centers, implement psychosocial support programs, with a cadre of 163 trained doctors, including four psychiatrists, 49 midwives to help women at risk of or experiencing postnatal depression, 446 trained workers, and 13 psychologists. However, the lack of financial support hinders access to psychological and social support, especially in light of the novel coronavirus (COVID-19) outbreak.

Maysa Derbas knew that there were psychological support centers. She also used to refer to those centers children in need of psychological support in the school in which she was working in the case management department. Yet, the social pressures prevented Maysa from seeking the assistance requested for herself, as highlighted by a close friend of Mayas, who refused to mention her name for the sensitivity of the topic.

Support projects for female victims are available within the psychological support programs in the health centers in Atme, intending to protect women from suicide, Obaida Radwan, director of the mental health project at UOSSM, told Enab Baladi.

The mental health project includes nine centers in Idlib governorate. It is presumed that the number of centers may increase to 17  in the future, according to Radwan. However, the region “is in great need of filling the psychological support gap,” as Radwan put it.

The causes of suicide in the region go beyond the internationally known causes, from financial distress, increasing living requirements, and violence against women, according to Radwan, to the lack of aid provided to the camps, in particular, and the availability of job opportunities only for men. 

The director of the mental health project indicated that the coronavirus affects keeping patients away from receiving treatment in health centers, with their fear of “people talking” if they seek psychological support.

How to help and support someone who attempted suicide?

Muhammad Satu, a psychiatrist, working in Idlib, told Enab Baladi that all suicide attempts are taken seriously.

Suicide, by definition, is the act of intentionally causing one’s own death for different reasons or motives. The reasons behind someone’s suicide attempt must be figured out to change the person’s negative view to positive, as Satu said.

Among the causes of suicide are suffering from chronic physical illness, severe depression, or exposure to sudden shock and loss, with economic and social pressures and life difficulties, or suffering from drug addiction.

The treatment of suicide attempt survivor goes through close monitoring, alerting his family not to leave him alone and keeping sharp objects out of his reach.  His family and close friends should treat him nicely, reprimanding him for his attempt, and urging him to pursue psychological treatment.  

The psychiatrist added that among the preventive and therapeutic methods needed to promote suicide attempt survivor is to mobilize family, and community support, including relatives, friends, acquaintances, and legal persons in the region, including clerics and specialists.

The majority of those who attempt suicide resort to hanging or inflicting multiple gunshots on themselves, or by ingesting poison or pills in large quantities.

 Satu indicated that most suicide attempts are committed by females, while the male suicide rate is higher because they use more dangerous methods of suicide.

Religious conviction and faith play a “big role” in people refraining from ending their lives despite pressures, as estimated by Satu.

Satu added that if the suicide attempt or suicidal thoughts stem from a psychological disorder such as depression, addiction, and psychotic disorders, then the mental and psychological hospital referrals must be made.

There are no psychiatric hospitals in the region, except a hospital located in the city of Azaz in the northern countryside of Aleppo, and while there are no immediate signs of an end to the economic and security crises in the region. Mental crises are also continuing, awaiting support, assistance, and attention to meet the needs for shelter, food, and medicines.