The invisible scars left by six years of war
At a mental health clinic in northern Syria, male patients with shaved heads squat in a courtyard, some in uniforms and others in T-shirts and tracksuit pants.
One man screams at those around him; another laughs to himself. A third sings exuberantly, exposing bare gums missing teeth.
The second floor houses female patients in patterned dresses and headscarves. Some smile at visitors while others lie motionless on their beds. One is tied to her bedframe.
The horrors of Syria’s six-year war have left its population with devastating psychological scars, but staff at the only mental health unit in the opposition-held north are doing their best to treat those affected.
Among the patients at the clinic in Azaz, northern Aleppo province, is a 17-yearold girl deeply scarred by the conflict.
“She saw a small child who had been killed and was being eaten by animals,” says Dorar Al Sobh, one of two doctors at the centre. “She was so shocked she lost her ability to speak. Now she can’t sleep or eat. She avoids everyone.”
A man from Raqqa province came back to his bombed-out home to find the bodies of his wife and six children.
“He has difficulty sleeping. He gets flashbacks and nightmares,” says Dr Sobh, 46.
Some cases predate the conflict but others – particularly those of post-traumatic stress disorder – have been caused by the war.
“Of course, we have seen an increase in cases, especially depression, PTSD and coping disorders,” Dr Sobh says.
Nurse Mohammed Munzer recalls receiving patients who were arrested at the peaceful protests in 2011 that led to Syria’s uprising.
“They were tortured and beaten, especially on the head. They started to have mental problems,” Mr Munzer says.
Others have developed anxiety caused by the relentless violence that has killed more than 330,000 people.
“There are people who can’t handle the sound of aeroplanes,” Mr Munzer says.
The unit serves nearly 140 inpatients and others who come from outside for care. It was originally set up in Masaken Hanano district of Aleppo city but it relocated after rebels entered the city in 2012.
“The hospital was hit in Masaken Hanano, wounding one of the nurses and handicapping him,” says the centre’s administrator, Mohyiddin Othman.
Many of the hospital’s medical staff fled leaving patients behind, some of them wandering the streets.
Alarmed locals contacted a Turkish medical charity, which works with Syrian doctors, to transfer the patients. By 2013, they had been moved to a base in Aleppo province, then to Azaz with help from the charity Physicians Across Continents.
While Azaz has been periodically targeted by regime strikes, particularly in the early years, the new hospital has not been hit. That has allowed staff to focus on their work, offering residents and outpatients medication, assessments and individual treatment.
At times they struggle to help those in need, such as a man who sought treatment for depression.
“I asked him once about suicide. He told me he didn’t think about it,” Dr Sobh says. “Fifteen days later he shot himself.”
The clinic also faces shortages of medicine. It receives occasional donations from the World Health Organisation, but often relies on alternatives bought on the local market or in neighbouring Turkey.
“We are psychologically exhausted,” Dr Sobh says. “Sometimes our patients hit us or curse us. Sometimes we take vacations to distance ourselves from the hospital atmosphere for a few days.”
The hospital basement is set aside for a kitchen and a cafeteria. Standing at tables or seated on the floor, patients eat stew and bread from metal bowls.
The centre is sparsely furnished, with long rows of beds for patients and washing lines hung with blankets.
In one room, a television is mounted on the wall and patients sit together watching.
The staff also do outreach in the community, hoping to tackle the stigma around mental health issues.
“We try to spread awareness in our surroundings and through flyers and social media, to explain that people who have mental illnesses are like anyone else who is sick,” Mr Munzer says.
Dr Sobh says the need for mental health care has caused a subtle shift in local sentiment.
“The presence of a treatment centre in this area is positive,” he says. “The residents of the area accept it and it’s no longer a sign of weakness.”