Enab Baladi – Jana al-Issa

Despite the need for around ten thousand doctors, the number of psychiatrists in areas controlled by the Syrian regime today does not exceed 75 psychiatrists, according to the latest statistics released by the Syrian Association of Psychiatrists last October.

This figure, which is considered minimal, does not in any way correspond to the scale of the need for this specialty, given the circumstances imposed on Syrians today, which highlight their urgent need for this field with the significant increase in rates of mental illnesses.

The decrease in the number of psychiatrists in Syria is not a new issue, as their numbers were modest even before 2011, reaching about 60 doctors across Syria before that year.

The problems of low wages in psychiatry, social stigma, and the stigma on mental patients and the doctor’s work are not new in Syrian society, and perhaps the current conditions have exacerbated the decline in numbers due to emigration of medical students before they commence their specialties, in addition to a strong desire among students to specialize in more profitable fields such as surgery and cosmetic medicine.

The need for ten thousand

Following the First International Conference of the Syrian Association of Psychiatrists held in Damascus at the end of September, the head of the Syrian Association of Psychiatrists, Dr. Mazen Khalil, spoke about the acute shortage of psychiatrists compared to the population in Syria, where their number does not exceed 75.

In a previous statement, the director of Ibn Sina Hospital for Mental and Psychological Illnesses in Syria, Ayman Daaboul, stated that Syria’s need for psychiatrists reaches around ten thousand doctors.

Khalil attributed the severe shortage to the emigration of many of them after graduation, especially in recent years, and the lack of encouraging incentives, while Daaboul attributed the main reason for the lack of interest in the specialty of psychiatry to “social stigma” and “the stigma on the mental patient” and the doctor’s work, as the psychiatrist is often portrayed as having “disheveled hair and a certain dress,” as well as financial factors and low wages for psychiatrists.

75% of Syrians are untreated patients

In Damascus, Ibn al-Nafis Hospital, which specializes in mental diseases, receives between 20 and 30 patients daily, presenting various cases resulting from pressure and difficult economic conditions, according to statements by the hospital director, Ayman Daaboul, in June 2022, at which time the number of admitted patients reached 500, in addition to 400 others in external hospitals.

According to the World Health Organization (WHO), 5% of adults worldwide suffer from depression, which is a common psychological disorder.

Moreover, more than 700,000 people commit suicide every year, making suicide the fourth leading cause of death among individuals aged 15 to 29.

In Syria, there used to be three hospitals specialized in mental health: Ibn Rushd Hospital in Damascus, Ibn Sina Hospital in rural Damascus, and Ibn Khaldun Hospital in Aleppo, whereas al-Mouwasat Hospital includes a section for psychiatry and an outpatient clinic, as does the Ministry of Defense under the Syrian regime and Tishreen Military Hospital.

A report by the World Health Organization released in 2020 indicated that 75% of people in Syria suffer from mental illnesses and do not receive any treatment.

According to the latest statistics released by the Syrian Association of Psychiatrists, 30% of the Syrian community suffers from multiple mental disorders from crises classified under what is called mental health, ranging from severe to mild, with 3% of them suffering from severe crises, which calls for an increase in financial and institutional support for research in the field of mental health and a focus on epidemiological studies to understand the prevalence of mental disorders in the community.

The impact of war is multifaceted

There should not be a focus solely on the number of doctors in the psychiatric treatment sector, as it is just one form of psychotherapy, according to experts. At the same time, they confirm that the number of 75 psychiatrists is very low considering the Syrian situation.

Dr. Haraqi explained in a conversation with Enab Baladi that specialist psychologists work on several aspects with patients, including biological, cognitive, behavioral aspects, and relationship problems, whether familial or marital, and their presence is vital in this field.

This demand in the sector can be addressed, according to Haraqi, through providing online services by doctors or psychological specialists residing outside Syria.

The physician emphasized that a society enduring wars requires much psychological care over many decades, and even when the war ends, there should be continued work on its psychological outcomes, which emerge more prominently after its conclusion, especially concerning family-related issues.

In addition to psychiatrists, the Syrian community needs psychological and family therapists and to raise awareness about mental disorders and their complications and the importance of seeking specialists.

Five reasons for the decline

Consultant psychiatrist Dr. Mamoun Mobayed mentioned to Enab Baladi that there are several intertwined reasons behind the decrease in the number of psychiatrists in Syria, the most prominent being the emigration of doctors across all specialties, displacement due to war, deteriorating security conditions, and low living standards.

A lack of resources and specialized training due to the war may have contributed to this, as specialized educational institutions faced difficulties in training doctors in this specialty, leading to a reduction in the number of qualified specialized staff, according to Mobayed.

The doctor clarified that undoubtedly certain segments of Syrian society experience social pressure due to the stigma attached to psychiatry, prompting some doctors to distance themselves from the field due to this stigma.

Additionally, the increasing and accumulating mental crises over the years have led to a heightened demand for psychological treatment, adding burden and pressure on the few existing doctors.

Mobayed believes that the decline in governmental support and international organization interest regarding mental health issues is a primary reason for doctors’ reluctance to specialize in psychiatry.

The mental health sector is at risk

The decline in the number of psychiatrists under these conditions has many negative impacts, according to Dr. Mobayed, noting that the most significant ones are the rising rates of undiagnosed and untreated mental disorders, and the increasing occurrence of suicide cases could be a strong indicator of this.

This will primarily affect the most vulnerable segments of society, especially children and adolescents, who are subjected to severe pressure due to conflict, migration, and displacement; without adequate psychological care, they may face long-term problems regarding their psychological, social, and family development.

Among the effects is the increased pressure on the remaining few doctors, who cannot find sufficient time for each patient, thus affecting the quality of diagnosis, treatment, and follow-up.

Without specialized psychological treatment, individuals may turn to self-treatment or folk remedies, some of which may involve superstitions or unethical methods, according to the physician.

The future decrease in the number of doctors, according to Dr. Mobayed, will lead to a reduction in interest and neglect of the entire mental health sector.

Steps to bridge the gap

It is imperative to work towards addressing the low number of psychiatrists, and for this, multiple strategies are needed to build the current workforce, to improve access to mental health care and raise awareness.

In this context, Dr. Mobayed stated that to remedy this deficit, it is necessary to bridge the gap by training medical staff other than psychiatrists, such as general practitioners, surgeons, or even nurses, on the basics of providing mental health care, enabling them to diagnose common cases and provide initial support, subsequently referring those needing psychiatric care to the few available psychiatrists.

Encouraging new medical graduates to specialize in psychiatry through incentives, financial grants, or providing suitable training for them is essential, according to the physician.

Psychiatric care remotely using technology can also be utilized to provide psychological consultations through specialists via communication.

Dr. Mobayed emphasized the existence of psychosocial support programs through the utilization of volunteers and community leaders, such as teachers and imams, since not everyone suffering from psychological crises requires a specialized psychiatrist.

The physician pointed out the necessity of intensifying mental health awareness campaigns in public hospitals, schools, primary health centers, and places of worship such as mosques and churches, among others.