Enab Baladi – Reham al-Sawadi

Bassam’s brother has been suffering from panic attacks for eight years, which began after witnessing members of the Islamic State organization executing four young men by gunfire in front of the public in the town of al-Sabha, east of Deir Ezzor.

Bassam told Enab Baladi that his brother suffers from nervous disorders and heart diseases. There was no one to treat him in the countryside of Deir Ezzor under the control of the Autonomous Administration of North and East Syria (AANES), so he bears costs beyond his capacity in an attempt to treat his brother in the city of al-Hasakah.

Bassam’s brother was not the only one in the area looking for a doctor. The city of Deir Ezzor is completely devoid of any psychiatrist or neurologist, and the same is true for the city of Raqqa, al-Tabqa, and other areas under the influence of the Autonomous Administration, whose residents suffer from a scarcity of psychiatrists, forcing patients to travel long distances and incur additional financial losses that “add insult to injury.”

Meanwhile, there are only a few doctors in the cities of al-Hasakah and Qamishli, ranging from three to four, according to what Enab Baladi monitored; only one of them is within the areas of influence of the Autonomous Administration, while the rest are inside the security square controlled by the Syrian regime.

The scarcity of doctors

Sidra (33 years old), from the city of Raqqa, lost her husband and her three children during the bombing by the International Coalition’s planes while the city was under the control of the Islamic State.

Sidra told Enab Baladi, “The sound of my child screaming and calling for me for the last time is still stuck in my ear, and his image never leaves my imagination.” She added that she thought about suicide many times, the latest of which was through an overdose of pills, but her brother immediately rescued her.

Sidra turned to a neurologist amid a scarcity of psychiatrists, who prescribed her some sedatives.

On the other hand, Enas (27 years old), from the countryside of Deir Ezzor, told Enab Baladi that the disorders she suffers began after a failed marriage relationship, which led her to isolation, in addition to what the region is witnessing in terms of conflict that does not call for happiness.

She added that the area lacks psychologists or therapists, nor does the community welcome the idea of ​​mental health treatment, describing those who seek help as insane, while the support of local organizations is limited to children.

A psychiatrist in the city of Qamishli told Enab Baladi that the scarcity of doctors is not new, as the situation exists all over the world, including Syria and northeastern Syria.

The doctor, who refrained from mentioning his name for security reasons, attributed the scarcity of doctors to the financial returns, which are considered low compared to other medical specialties, in addition to the lack of awareness of the importance of the psychiatrist’s role.

Mental illness is a disorder in brain chemistry, a deficiency or excess in certain neurotransmitters, and in psychiatry, the word “crazy” does not exist and it does not deal with it.

Additional costs

When Thamer’s family was displaced from Deir Ezzor to al-Shaddadi in the countryside of al-Hasakah after the battles intensified between the International Coalition and the Islamic State organization in 2016, his cousin’s daughter Zahra lost her house key along with official papers and her identity documents, causing a problem between her and her husband.

Since that time, Zahra has been looking for the key everywhere, asking everyone she knows about it.

Zahra’s family is forced to go to Qamishli to consult a specialized psychiatrist because there is no doctor in al-Shaddadi after they tried going to neurologists and religious sheikhs to no avail.

The family bears the travel expenses, in addition to the consultation fees of 50,000, and the cost of medicines which reach up to 100,000 Syrian pounds.

Zahra sees the doctor secretly for fear of social stigma.

The stigma and the community’s non-acceptance of the idea of mental illness prevent the patient from consulting a psychiatrist, preferring to go to other specialties or to consult a doctor from outside their area, according to the psychiatrist in Qamishli.

What is the role of organizations?

A worker from the Mehad organization, which operates in northeastern and western Syria and identifies itself as a French non-governmental organization working in the field of health and international solidarity, told Enab Baladi that many organizations work on providing psychological support, individual sessions, psychosocial support, and others in northeastern Syria.

However, the scarcity of doctors and mental health specialists has led the organizations to resort to bachelors of social work (BSW) who have undergone certain training on the concept of health and topics specialized in mental health.

Not all graduates have sufficient experience to communicate with and deal with patients, and many of them work outside their roles, confined to guiding patients about the concept of health and mental disorders, and the importance of consulting a doctor if certain symptoms are felt.

The worker, who also refrained from mentioning his name for security reasons, pointed out that the BSWs mix their personal beliefs with psychological counseling and interfere in the patient’s decision, which sometimes determines their fate.

The organizations in al-Tabqa and Raqqa follow a referral system in an attempt to avoid providing advice from unqualified individuals.

The system works on receiving the patient, or the beneficiary as the organization named it, and arranging an appointment for them with a psychiatrist who comes once a week from Qamishli to Raqqa and al-Tabqa because the number of doctors in the region is “zero,” according to the worker.

The worker in the organization pointed out that only one doctor travels between Qamishli, Raqqa, al-Tabqa, al-Karamah, and Manbij to treat patients.

Complications, untreated cases

According to unofficial estimates, about one million Syrians (4% of the population) suffer from severe mental disorders, while 5% have moderate mental disorders.

In 2018, the Syrian Psychiatric Association recorded 80 psychiatrists working in Syrian territories, creating challenges for both patients and doctors.

A doctor who met with Enab Baladi in Qamishli believes that the number of doctors is not proportional to the cases in the region, increasing the workload on the doctor. As a result, the patient does not receive their due care. Moreover, some are unaware of the presence of a doctor in the area, remaining untreated until their condition worsens and reaches a chronic stage that is difficult to treat.

Enab Baladi’s correspondent in Deir Ezzor, Obadah al-Sheikh, contributed to this report.