Lone clinic in Syria’s rebel north tackles mental toll of war
AZAZ: At an austere mental health clinic in northern Syria, male patients with shaved heads squat barefoot in a courtyard, some dressed in uniforms and others in T-shirts and tracksuit trousers.
One man screams at those around him, while another laughs to himself. A third sings exuberantly, exposing bare gums missing teeth.
The second floor houses female patients in patterned dresses and flowery headscarves.
Some smile at visitors, while others lie motionless on their beds. One woman is tied to her bedframe.
The horrors of Syria’s six-year war have left the country’s population with devastating psychological scars, but staff at the only mental health facility in Syria’s oppositionheld north are doing their best to treat those affected.
Among the patients at the clinic in Azaz, northern Aleppo province, is a 17-year-old girl.
“She saw a small child who had been killed and was being eaten by animals,” said Dorar al-Sobh, one of two doctors at the facility.
“She was so shocked, she lost her ability to speak. Now she can’t sleep or eat ... she avoids everyone.”
A male patient from the neighbouring province of Raqa came back to his bombed-out home to find the lifeless bodies of his wife and six children.
“He has difficulty sleeping ... he gets flashbacks and nightmares,” said Sobh, 46.
Some cases predate Syria’s con- flict, but others – particularly of posttraumatic stress disorder – have been directly caused by the war.
Nurse Mohammed Munzer recalled receiving patients who had been arrested during the peaceful protests in 2011 that kicked off Syria’s uprising.
“They were tortured and beaten, especially on the head. They started to have mental problems,” the 35-year-old said.
Others have developed anxieties related to the relentless bombing and violence that has killed more than 330,000 people.
The facility serves nearly 140 inpatients, as well as others who come from outside for care.
It was originally set up in Masaken Hanano district on the northeastern outskirts of Aleppo city.
But it was forced to relocate when fighting broke out after rebels entered the city in 2012.
“The hospital was hit in Masaken Hanano, wounding one of the nurses in his hand and handicapping him,” said facility administrator Mohyiddin Othman.
Many of the hospital’s medical staff fled and left patients behind, some of them wandering the streets.
Alarmed residents contacted a Turkish medical NGO that worked with local Syrian doctors to transfer the patients.
By 2013, they had been moved first to a facility in western Aleppo province, and then to Azaz with help from charity group Physicians Across Continents. While Azaz has been periodically targeted by regime strikes, particularly in the early years after the patients were moved to the area, the new hospital has not been hit.
That has allowed medical staff to focus on their work, offering residents and outpatients medication, assessments and one-on-one treatment.
At times they struggle to help those in need, such as a man who regularly visited Sobh to seek treatment for depression.
“I asked him once about suicide. He told me he didn’t think about it,” Sobh said. “Fifteen days later he shot himself.”
The hospital also faces shortages of medicine. It receives occasional donations from the World Health Organisation, but often relies on alternatives bought at the local market or in neighbouring Turkey.
For the facility’s staff, these challenges can feel overwhelming.
“We are psychologically exhausted,” said Sobh. “Sometimes our patients hit us or curse us ... Sometimes we take vacations to distance ourselves from the atmosphere of the hospital for a few days.”
The staff also do outreach work, hoping to tackle the stigma around mental health issues.
Sobh said the growing need for mental healthcare has caused a subtle shift in local sentiment.
“The presence of a treatment centre in this area is positive,” he said. “The residents accept it and it’s no longer a sign of weakness.”