On June 16, 2003, Dr. Ali Hameed Rasheed, an Iraqi psychiatrist, submitted a proposal to the Ministry of Health in Baghdad to create a psycho-social mental health referral system for children in Iraq. Though such systems already exist in many countries, Iraq is lacking one. The goal of the Post Traumatic Stress Disorder (PTSD) Program for Iraqi children is to increase mental health awareness and reduce stigmatization of mental illness in the community.

Dr. Rasheed’s focus is on the children of Iraq who have been experiencing unbelievable desensitizing and traumatic experiences over the past 15 years. The main source of their trauma has been from three wars and twelve years of economic sanctions. This PTSD Program was developed to train adults who come in regular and consistent contact with children to recognize symptoms of mental distress and refer the children to professional mental health workers for help. Therefore, training for recognition of mental health distress is to be provided to teachers and primary health care workers with the aid and collaboration of religious leaders in local communities.

An American Department of Defense senior advisor to the Iraqi Ministry of Health accepted the proposal, but after only two months he asked for results. “He thought we were working on the preparation of quick meals for the children ... I told him that it was just the first step in a program that will take 10 or more years. He failed to understand the way we were working and he decided to stop funding [the program],” Dr. Rasheed says.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM III), the diagnosis of determining post-traumatic stress disorder include a person who has persistently re-experienced an event that is outside the range of usual human experience—an event that would be markedly distressing to almost everyone. In children this symptom usually shows up in repetitive play in which themes or aspects of the trauma are expressed. Those who suffer from PTSD also persistently avoid stimuli associated with the trauma.

Children usually experience a loss of recently acquired developmental skills such as toilet training or language skills. Dr. Rasheed points out that “of the recognized features that most [Iraqi] students have are a lack of initiative, poor interest in school, a declination of scholastic achievement and performance, and a loss of [recently] acquired [developmental] skills.” 

A colleague of Dr. Rasheed’s did a study on a minor scale, examining 1000 school children in Iraq. “The study showed the prevalence of conduct disorders and other emotional disorders; some are considered normal so the parents and teachers will never seek advice. That’s why I feel that mental health awareness is a very important task and goal,” Dr. Rasheed remarks.

As a teacher in America I have been trained to recognize symptoms of mental health distress in my students. Of course the procedure is to consult the parents and refer the child to the school psychologist for further assessment. I was rather surprised that Iraq did not have such a referral system and Iraqi teachers were not properly trained to recognize symptoms of mental health disorders.

Children and Teachers Under the Former Regime

The impact of the former oppressive regime and twelve years of economic sanctions has been profound on the entire education system and therefore the teachers and children.

Emad Hadi, the administrator of Childhood Voices, an Iraqi NGO, explains that, “the [Baath] Party’s major aim was set on the children. The regime made sure that military training in specialized centers was well publicized in order to prepare the youth militarily to face the enemy—as it claimed.

“Children were asked to perform duties way beyond what a child could bear, usually methods that were contrary to all acknowledged children’s rights. These duties included forcing the children to eat raw meat, train and fight continuously and jump from heights.”

According to Wathah Alani, a doctoral candidate at the University of Wisconsin and a Baghdad native, after school and over the summer all boys were required to attend military training camps where they learned how to use AK-47s and how to march in proper formation.

Alani recalled witnessing physical punishments such as spanking with a hand or stick; and boys could be expelled from school or have their families sent to jail if they did not attend those training camps. Overall, the culture of the entire society was one of fear and intimidation, which gave the former regime a lot of control.

Teachers also suffered under the former regime. Bushra Alsamaraey has been a girls’ secondary school English teacher in Baghdad  for 15 years. She recalls the extremely low pay for teachers. Usually, the pay came out to about $5.00 per month. The greatest incentive the Baath Party offered teachers for higher pay was to join the party. Some teachers did so reluctantly as a matter of survival.

Teachers were constantly under surveillance by Baath Party officials to make sure they were doing as they were told to do by the government, Ms. Alsamaraey says.

Subhan Allah (Glory be to Allah), the textbooks Alsamaraey is still using today to teach English are the very same ones she used when she used as a student in secondary school.

Ahlam Daffar is an Islamic history teacher for secondary students in   Babylon. Ms. Daffar says now salaries for teachers have increased to $200-$450 per month; however, the class size is still way too large (40-50 students per class). She is hoping that the issue of class size will be addressed soon.

Treatment for PTSD in Iraq?

Dr. Rasheed sees child-friendly psycho-social wellness centers as a critical element to healing post-traumatic stress syndrome and bridging the gap between students and school, since one of the main symptoms of PTSD in children is a disinterest and poor performance in school.

“These wellness centers make school more loveable and appealing to the child and therefore can help the children build coping strategies [to deal with the trauma they have suffered],” Dr. Ali Rasheed explains.

Childhood Voices has set up at least three such centers in Baghdad. Kurdistan Save the Children has started a similar center in northern Iraq. Essentially, these child-friendly psycho-social wellness centers offer children a safe place to learn computer skills, draw, paint, write, sing and participate in theater projects.

Kurdistan Save the Children has also established an orphanage for street children in Baghdad. Asmaa Rasheed, the director of the facility, says they are currently housing about 30 children who would otherwise be homeless. They, moreover, offer recreational and educational opportunities for children.

“Spirituality and Trauma Treatment”

In an article titled “Spirituality and Trauma Treatment,” published in the National Center for Post Traumatic Stress Disorder, in the USA, Kent D. Drescher and David W. Foy wrote that there is strong evidence that faith and spiritual beliefs can play a vital role in healing people who suffer from PTSD as well as provide good coping strategies.

“Religious beliefs and practices [spirituality] are traditions through which many people develop personal values and their own beliefs about meaning and purpose in life. Among mental health professionals there is an increasing recognition that many patients view spirituality as a primary human dimension. Indeed, current concepts of coping strategies are evolving to include spiritual beliefs and practices along with other social, emotional, physical and cognitive aspects as important coping resources.” In fact, Dr. Rasheed and his colleague Dr. Alhashimi have begun the first steps towards establishing psycho-social wellness centers in local mosques in Baghdad.

“I believe that we need faith to build new techniques and strategies [for coping], making use of reading the Quran and praying to help build immunity and relief of the daily agony we are facing,” Dr. Rasheed explains.

One of the greatest obstacles for Iraqis who are going to great lengths to help Iraqi children suffering from post-traumatic stress disorder is the lack of funding for their various projects. The United Nations left Iraq one year ago and until now the UN and UNICEF have hardly provided any funding for projects aimed at healing Iraqi children from the effects of the trauma of war. Dr. Rasheed has received some private funding for a project in Babylon to train teachers, parents and primary health care workers about PTSD in children, but not from UNICEF. Ultimately for Dr. Rasheed and other psychiatrists, it would be ideal to establish the PTSD social referral system throughout all of  Iraq, in sha’ Allah (Allah willing).

Another vital need in Iraq is professional development for mental health professionals and support from child psychiatrists. Subhanallah, to this day, there is not one specialized child psychiatrist in all of Iraq.

Children can be amazingly resilient. With the help of Allah the Most High, and then the dedication of mental health professionals, parents, teachers, primary health care workers, and religious leaders, in sha’ Allah the mental, physical, emotional and spiritual well being of Iraqi children will be taken seriously and urgently addressed.

The well being of Iraqi children is critical to the future of Iraqi society and to the future of our Ummah (community of Muslims) as a whole.

For further inquiries Dr. Rasheed may be contacted at ptsdprog2003@hotmail.com.

Aisha Robertson is an American teacher and freelance writer based in Wisconsin, USA. Holding a BSc in Education from the University of Wisconsin, Aisha has worked as a teacher since 1991. She may be contacted at aishar@islamonline.net.