Establishment of Child and Adolescent Psychiatry in Iraqi Kurdistan

Abdulbaghi Ahmad

Department of Child and Adolescent Psychiatry
Uppsala University Hospital
S-751 85 Uppsala, Sweden
E-mail: abdulbaghi.ahmad@bupinst.uu.se

Background

Psychological problems among children of Kurdistan attracted international attention for the first time through the child interviews conducted during the "mass-escape tragedy" (MET) of 1991 in various parts of Kurdistan. Children's posttraumatic stress reactions during and after the catastrophe were analysed and described previously [1].

As with all man-made disasters, children were the main victims of MET of 1991. Through interviews in the primary refugee camps on the border between Iraq and Turkey [2], children reported many psychological symptoms two months after the catastrophe. However, the severity of the symptoms declined four months later when the children returned with their families to their homes under United Nations (UN) protection [2]. Strong family ties and cultural duties/responsibilities were among the protecting factors for children during the MET. Conversely, previous up-bringing in city milieu and paternal absence during the MET were two obvious vulnerability factors.

One year after the MET, the symptoms attributed to posttraumatic stress disorder (PTSD) increased in severity and remained high even at the two-year follow-up [3]. The general depression suffered by adults through political disappointments after their repatriation, and the accompanying difficult socio-economic circumstances further reduced adults support for children. The latter added to the on-going deterioration of psychological problems among children (Fig. 1, 2).

Figure 1: A Kurdish boy cutting wood

Figure 2: A Kurdish girl holding her little sibling

To further illustrate the value of parents' availability for the mental well-being of children, a follow-up study of orphans was conducted in the liberated "save-haven" of Iraqi Kurdistan between 1992 and 1993 [4]. Children who were hosted in traditional foster-care homes in the provinces of Sulaimani and Dohuk revealed improvement in competence and behaviour, whereas those in orphanages deteriorated over time. The results indirectly suggested that the family as a protecting factor for child mental health. This hypothesis was further supported by a subsequent study on the survivors of the so called "Anfal Operations", a systematic genocide campaign executed by the Iraqi military in rural Kurdistan [5]. In this process, much the Kurdistan countryside was destroyed, ten-thousands of families were killed, displaced or deported to concentration camps elsewhere in Iraq. It was estimated that over 87% of the displaced children fulfilled the criteria of PTSD. These studies increased awareness of child mental health problems in Iraqi Kurdistan and generated increasing interests for the creation of child mental health services in the region.

Department of Child Mental Health

The Department of Child and Adolescent Psychiatry at Uppsala University in Sweden was involved from the beginning in the attempts to build a "Child and Adolescent Psychiatry" centre in Iraqi Kurdistan. The first project (named HAWAR) in the city of Dohuk on 29 July 1992 as a collaborative project between the Department of Paediatrics of Dohuk General Hospital and Uppsala University in Sweden. In 1998, a new collaborative initiative was launched between the Department of Neuroscience, Child and Adolescent Psychiatry at the Uppsala University, and the College of Medicine at the University of Dohuk. Funded by the Swedish International Development Agency (SIDA), a research project was conducted on childhood trauma and mental health in the city of Dohuk between1998 - 2001. These efforts finally lead to the inauguration of the Department of Child Mental Health (DCMH) at the College of Medicine, University of Dohuk on 20 September 2001 (Fig. 3: photo of DCMH).

Figure 3: Map of Kurdistan, arrows indicate Iraq-Turkey border

The main function of DCMH is to build up competence in child mental health in Kurdistan region with the assistance of the partner organisation, Child and Adolescent Psychiatry at the Uppsala University. The DCMH is managed by the Founding Director (the author), assisted by an Advisory Board, consisting of international and local experts. Local staff are trained (by visiting Swedish partners) in community-based undergraduate and postgraduate programs, clinical management of patients, management of staff and conducting research projects. Further details on the collaborative project are on www.neuro.uu.se.

Since 2001, the subject of Child and Adolescent Psychiatry is obligatory in the undergraduate education program for the medical students at the College of Medicine, University of Dohuk. The postgraduate education program provides High Diploma, Master degree and specialist certificates in Child and Adolescent Psychiatry, making the University of Dohuk the first University in the Middle East to deliver this speciality. The Department has already awarded Master degrees to graduates in since 2004, it has supported local authorities for several community-based programmes relating to concerning social care, school system and the primary care.

References

1. Ahmad A. (1999) Childhood trauma and posttraumatic stress disorder, a developmental and cross-cultural approach. Acta Universitatis Upsaliensis. Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine: Uppsala.
2. Ahmad A. (1992) Symptoms of post-traumatic stress disorder among displaced Kurdish children in Iraq; victims of a man-made disaster after the Gulf war. Nordic Journal of Psychiatry. 46(5), 315-19.
3. Ahmad A., Mohammad H., Ameen N. (1998) A 26-month follow-up of posttraumatic stress symptoms in children after Mass-Escape Tragedy in Iraqi Kurdistan. Nordic Journal of Psychiatry. 52(5), 357-66.
4. Ahmad A., Mohamad K. (1996) The socioemotional development of orphans in orphanages and traditional foster care in Iraqi Kurdistan. Child Abuse and Neglect. 20(12), 1164-73.
5. Ahmad A., Sofi M. A., Sundelin-Wahlsten V., von Knorring A-L. (2000) Posttraumatic stress disorder in children after the military operation "Anfal" in Iraqi Kurdistan. European Journal of Child and Adolescent Psychiatry. 9, 235-43.
6. Sundelin -Wahlsten V., Ahmad A., von Knorring A-L. (2001) Traumatic experience and posttraumatic stress reactions in children and their parents from Kurdistan and Sweden. Nordic Journal of Psychiatry. 55(3), 395-9.
7. Sundelin -Wahlsten V., Ahmad A., von Knorring A-L. (2001) Traumatic experience and posttraumatic stress reactions in children from Kurdistan and Sweden. Acta Paediatrica. 90, 563-8.
8. Sundelin -Wahlsten V., Ahmad A., von Knorring A-L. (2002) Do Kurdistanian and Swedish parents and children differ in their rating of competence and Behavioral problems? Nordic Journal of Psychiatry. 56, 279-83.
9. Ahmad A., Qahar J., Siddiq A., Majeed A., Rasheed J., Jabar F. von Knorring A-L. (.2005) A two-year follow-up of orphans' competence, social and psychological problems in traditional foster care and orphanages in Iraqi Kurdistan. Child; Care, Health and Development. 31(2), 203-15.