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Seven years after the end of the war, the trauma of conflict and displacement is still prominent in Northern Iraq.
Many Iraqis have experienced protection and mental health issues in the last two decades due to exposure to distressful events, human rights violations, disruption of social networks, loss of property, and harsh living conditions. Almost one fifth of displaced individuals living outside of camps report psychosocial distress, preventing them to perform daily tasks and resume their lives¹. Coupled with challenges in securing income sources, displacement-affected communities continue to suffer from psychological, social and mental pressures. Yet, mental health support is not widely available as most health centers do not provide those services and mental health is not systematically part of the training curriculum for health workers. This gap in mental health services results from the lack of public investment in mental health services and qualified professionals, as well as the persistence of stigma and misconceptions around mental health disorders.
In 2022, Action contre la Faim launched a capacity-building program to bridge the gap in mental healthcare in Iraq, to improve access to quality treatment for people struggling with mental health and psychosocial challenges.
Baraa, 30-years old, works for the Directorate of Health (DoH) of Ninewa, as the Senior Head of Laboratory. She participated in one of the trainings organized by Action contre la Faim on mhGAP, which is a program recommended by the World Health Organization to scale up services for mental, neurological and substance use disorders. In Mosul, Baraa confirms that many individuals struggling with mental health challenges continue to face challenges in being properly diagnosed and in accessing adequate care in primary healthcare centers. These people continue to struggle with symptoms of depression, epilepsy and other disorders resulting from un/under-addressed trauma. Yet, access to mental health and psychosocial support training is not widely available for DoH staff in Mosul: “Before joining the “mhGAP” program provided by Action contre la Fail, I did not know much about psychological and psychosocial support, due to the lack of training and qualified professionals in Mosul”.
During the training, she was oriented on patient case management, counselling and supervision to build her skills in dealing with mental health and psychosocial problems. She believes that the programme had a positive and effective impact: “it contributed to the activation of mental health units and departments in primary health care centers across Ninewa, facilitating citizens’ access to mental health services while also supporting health and medical staff in primary health centers through self-care”. Besides, Barra considers that the programme led by Action contre la Faim widely spread awareness among health workers around mental health problems and services. “The program contributed to building the skills of health staff, enabling them to support more patients with quality services” explains Baraa.
Thanks to the training, Baraa is now able to identify mental health cases and provide them with a quality diagnosis, therapeutic intervention and follow up. “In parallel of my daily work, I can better identify members from my community suffering from mental health and psychosocial distress”, she explains. She is now able to identify the different signs and symptoms of distress, develop an adequate treatment protocol and follow-up on the patient’s recovery. “When the level of suffering is too high, the person is referred to a psychiatrist, in the hospital”. She remembers supporting one women struggling with mental health: “she was a student and faced poor performance in school due to psychosocial distress,” remembers Baraa. She mobilized the techniques learned during the mhGAP training to help her cope with her mental health condition. With the support provided, Baraa happily confesses that she became shortly after one of the best students in her class. “I was very pleased to see her wellbeing and mental health improve”.
More than ever, Baraa is committed to making the most out of the skills and experience she acquired through the training: “I want to continue to support other patients suffering from various disorders”. However, she remains lucid and stresses the need for more investment in mental health services. Going forward, she hopes to see similar trainings provided to both male and female health providers, to improve access to inclusive and safe mental health care. Investing in mental health service providers is essential. She also believes that challenges to secure stable incomes and access employment opportunities can really exacerbate psychosocial and mental health problems. For her, it is crucial to link psychosocial support with employment opportunities, in order to durably address mental health challenges among displacement-affected communities in Iraq. “This will contribute effectively in reducing the spread of psychological conditions, such as suicide, divorce, family disintegration”.
Maha, 33 years old, participated in the mental health, psychosocial support and protection training provided by our teams. She is very active in her community’s volunteer team and has previously participated in financial support and psychosocial services programs provided by humanitarian organizations to displaced and returnees families. Through her volunteer works, she noticed that “severe mental illnesses are very common, but acceptance issues remain the biggest challenge”. According to her, “the stigma around mental health is still highly present, and results from misconceptions that are entrenched in our community, leading to the alienation of people with mental health conditions”. Without access to quality mental health services, she deplores the increase in self-harm and cases of violence in the Iraqi society. Maha is convinced that raising awareness around mental health services is crucial to break the stigma and build community acceptance of mental health services. She also stresses the need for the provision of mental health services in health centers, including psychological group support and individual sessions.
Maha attended the training provided by Action contre la Faim on basic mental health, psychosocial and protection support and referral pathways. Through the session she built her understanding of mental health and protection risks faced by survivors of violence, especially such as addiction, drug abuses and suicide.
“The skills and experience gained helped me to provide awareness sessions in several areas inside Mosul. I have more energy and knowledge to raise awareness on psychological issues, and help communities identify and support people who suffer from mental health problem”. Maha also uses what she learns during the training to help her relatives: “I shared the information that I learned with family, my friends, and my volunteer team inside Mosul city”.
She was able to identify community members struggling with mental health issues, such as anxiety and depression, and refer them to primary healthcare centers for appropriate care. She is now very eager to learn more about mental health support, and continues to raise awareness across her community to break the stigma around mental health.
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