Adam Jawad escaped Iraq with his family following the US-led invasion in 2003, living in Syria until war forced him to flee again a decade later, this time to Jordan, where he eked out a living doing odd jobs and working at a cultural centre in the capital, Amman.
Jawad wrote scripts for short movies and sometimes performed as a DJ and rapper, but he felt his aspirations were impossible to realise and saw no future for himself in Jordan. Without the freedom to travel outside the country, and unable to find the support he needed to cope with trauma and displacement, despair took over.
“Amman is a prison,” he wrote in his last post on social media, a few hours before he ripped out the pages from his Iraqi passport and took his own life last November. He was just 27.
A rising number of people in Jordan are choosing to end their lives. The government’s National Institute for Forensic Medicine registered 169 suicides in 2020 – the highest number in a decade (and the latest year for which official statistics are available) – but experts believe the real numbers are probably much higher, since deaths by suicide are often underreported due to the stigma of discussing the issue.
While it’s not easy to pinpoint the exact cause, life is becoming increasingly difficult for many in the country. Unemployment rates have soared to nearly 25 percent, reaching 48 percent among youth. Last February, young Jordanian men protesting against unemployment threatened to take their own lives if their demands for jobs were not met. Then there are the rising rates of depression among refugees, many of whom carry the trauma of war and prolonged displacement, paired with a critical lack of support.
The government’s response to the crisis has been to criminalise public suicide attempts. Last month, Jordan’s parliament approved an amendment to the country’s penal code, which would punish attempted suicide in public spaces with up to six months in jail, as well as a fine of 100 Jordanian dinars ($140). The law still needs to be ratified by King Abdullah II, who holds the power to promulgate all laws passed by parliament’s two houses.
Jordan’s Prime Minister Bisher Al-Khasawneh has defended the law as a way to “protect the right to life” and “maintain public security”. But for people like Dr. Walid Sarhan, a psychiatrist who has spent decades campaigning for mental health awareness in Jordan, the government's proposal to criminalise suicide attempts in public is “a catastrophe”.
Sarhan worries that the law will punish and incarcerate people who are sick, and discourage many from looking for help when they may need it most.
“Instead of punishing people who attempt to commit suicide, we should be focusing on improving mental health services,” Sarhan told The New Humanitarian.
Refugees particularly vulnerable
There is only around one psychiatrist for every 100,000 people in Jordan, according to the World Health Organization. In addition to services provided by public hospitals and private clinics, just a few NGOs provide mental health services and psychosocial support to refugees and vulnerable Jordanians who are unable to afford treatment. But Sarhan says needs far exceed the services provided.
“Public hospitals are understaffed and overcrowded,” he said. “Services need to be upgraded and we need more training and investment, but very little has been done to improve mental health care over the last two decades,” he said.
According to a 2020 report by the International Medical Corps, most people with symptoms of mental illness in Jordan do not ask for help, and very few follow up with treatment. Other recent studies of mental health services in the country found that financial limitations, stigma, and poor accessibility to – and shortages of – mental health professionals were the main barriers to treatment.
These obstacles pose a particular challenge for Jordan’s refugee population – one of the world’s largest in terms of proportions of refugees per capita. More than 760,000 refugees, mostly from Syria and Iraq, are registered with the UN’s refugee agency, UNHCR, but the unofficial number is estimated at around 1.3 million.
The consequences of the prolonged COVID-19 pandemic and deteriorating socio-economic conditions have been particularly hard for these communities; about 80 percent of Jordan’s refugees live below the poverty line, with 60 percent in extreme poverty. UNHCR surveyed refugees who do not live in camps earlier this year, and 28 percent said they experienced high or severe levels of depression.
“Consultation rates increased by over 50 percent in 2021, the mental health situation deteriorated, [and] there are increasing reports of suicide attempts and suicidal thoughts,” said Ahmad al-Shibi, who coordinates International Medical Corps’ Mental Health and Psychosocial Support programme supporting refugees and vulnerable Jordanians.
The organisation runs psychotherapeutic care centres across the country, providing free services to about 8,000 patients a year.
“There are more people in need of mental health services, but at the same time there is donor fatigue,” said al-Shibi. “Jordan is facing a difficult situation because needs are increasing, but funding is being reduced.”
With over a decade of conflict in Syria, and the Ukrainian war overshadowing crises in the Middle East, international assistance is being cut and humanitarian programmes are shutting down. Mental healthcare in Jordan is already underfunded in the public sector, too: Experts told The New Humanitarian that less than two percent of the country’s total health budget goes towards mental health.
Jordan’s refugee population is likely to be particularly in need of the few services that do exist. Dr. Mohammad Abo-Hilal, a Syrian psychiatrist who has worked in Jordan, said refugees are at increased risk of psychiatric disorders as they are more vulnerable to the traumatic effects of violence, loss, the destruction of homes and livelihoods, and prolonged displacement.
Abo-Hilal had fled in 2011 to Jordan, where, together with Syrian psychologists, he set up an NGO that provides psychiatric and psychosocial support to refugees and raises awareness about mental health issues.
Non-Jordanians are barred from certain professions in Jordan, and Abo-Hilal was unable to work as a clinical psychiatrist in the country. He moved to Turkey in 2014, where he continues to work with refugees. He believes that a community-rooted approach is the best way to address the current mental health crisis and reduce the stigma that prevents many from looking for help.
“Suicide is not just about mental health, and it’s not an individual issue,” said Abo-Hilal. “It’s also about deteriorating living conditions, about a lack of basic needs, and about social injustice. So we need to deal with it as a collective issue, and to look at the structural problems to be able to solve it.”
Suicide as a political and social issue
Shaken by the loss of their friend and alarmed by the rise in depression and suicidal thoughts among young people, members of Jadal, the cultural centre where Jawad used to work, decided to host a collective mourning session and organise events to raise awareness about mental health.
“We are not talking about individual acts of despair,” he said. “It’s collective suffering, so it takes a collective approach to solve it.”
“Our goal is to create a safe space for people to know they are not alone,” said Fadi Amireh, Jadal’s co-founder and a close friend of Jawad’s. For Amireh, the reasons behind the rising suicide rates in Jordan are political, social, and economic. “We are not talking about individual acts of despair,” he said. “It’s collective suffering, so it takes a collective approach to solve it.”
Others in Jordan are creating campaigns to change the stigma around mental health and suicide and making resources available online for anyone seeking mental health treatment.
Hareb, which means “fight” in Arabic, a social media campaign started by psychiatry resident Yazan Halasa, conducts awareness-raising sessions to promote mental health as an essential component of health, and to combat the perception of mental illness as weakness. Circle of Hope, a youth-led organisation founded by psychologist Renad al-Qurani in 2019 when she was still a student, is collecting information about psychosocial support to make it easier for people to look for help in Jordan.
“We gathered resources on mental health and will make them available online so people will know where to find help and also be able to find more information about therapy and mental health,” al-Qurani told The New Humanitarian, adding that Circle of Hope will soon launch a website with listings of psychiatric and psychological service providers.
Psychiatrist Sarhan has also created an online campaign to fight mental health stigma in the Arab world, and is working with a psychologist and a publisher to create booklets on mental health to distribute in Jordanian schools. But he told The New Humanitarian that awareness-raising initiatives are not enough.
“We need to be able to provide proper mental healthcare services,” he said. “What’s the point of raising awareness and telling people they are sick if then we are not able to provide treatment?”
Amireh of Jadal believes the only way to push back against the proposed new law and lack of mental healthcare in Jordan is to band together. “Instead of addressing the structural problems, the government is trying to punish and repress the symptoms of the crisis,” he said. He pins his hopes on community-based initiatives providing support and mutual aid. “We need to stand in solidarity with each other, to take responsibility for our own societies and to take care of each other.” In the end, he said, “that’s all we have”.
If you are in crisis, click here to find a helpline near you (via the International Association for Suicide Prevention).
911: A hotline run by Jordan’s Family Protection Department can be reached via the general emergency number
1564: Embrace National Lifeline
Edited by Helen Morgan.