Plans underway for mental health centre in Arbil

A delegation from a Greek NGO is due to arrive in Arbil this week to look into the viability of its plans to strengthen northern Iraq's almost non-existent psychiatric care system. Well known in Greece both as an advocate of the socially excluded and for its seven small rehabilitation centres for the mentally ill, the Klimaka NGO intends to build a 150-bed hospital in Arbil governorate, at the centre of the Kurdish-controlled north. "These are very early days," Dr Iannis Kakoulas, a clinical psychologist and member of Klimaka's administration, told IRIN from the Greek capital, Athens. "All that we know for sure so far is that mental health facilities as we know them in the West do not exist down there and that the Kurdish authorities are interested in having our help." There is a mental asylum in the city of Arbil, but it is run by the Kurdistan Democratic Party (KDP)- all powerful in the area - rather than by the local department of health. According to Nazar Mohamed Amin, a psychiatrist and vice-chancellor of Sulaymaniyah University, there are fewer than a dozen trained psychiatrists in the three Kurdish-controlled governorates of Arbil, Sulaymaniyah and Dahuk. "The lack of local specialists is a problem, but not an insurmountable one," said Dr Kakoulas. "Our project is two-sided: building the facilities and training future staff." With a number of practising clinical psychologists and psychiatrists on its board, Klimaka has already contacted the psychiatry departments of universities around Greece and Europe for advice on the content of a psychiatric care curriculum it plans to set up in northern Iraq. "We're banking on a 500-hour course," Dr Kakoulas explained. "But it remains to be seen whether we will have to train staff from zero, or just top up what they know already." Both the training and the hospital would be set up in collaboration with Arbil University's medical school. Klimaka has already received a pledge of most of the 3 million euros (US $3.74 million) it expects the project to cost from the Greek government. It continues to look for extra funding, both from international bodies and from within Iraq. The trip to Arbil represents the second stage of the project. Apart from making contact with local authorities, Klimaka's aim when it first visited the region this March was to assess local attitudes towards mental illness. It was to broaden that assessment that Klimaka sent a four-strong local medical team around 20 villages in Baradost, a remote mountain district near the intersection of the Turkish and Iranian borders. Only one of the villages the team has been visiting has a clinic, staffed by a medical assistant. The closest doctor is in Diyana, over an hour away. "Our primary job up here is basically that of any mobile medical team," team doctor Kerwan Bergali told IRIN in the village of Kazkak. "We do check-ups on the villagers and give them free drugs when needed." Most of the problems he has seen are typical of rural Iraq: around 80 percent of the women, he said, suffer from urinary tract infections. A meat-deficient diet accounts for high levels of anaemia. And the altitude of the villages - up to 2,000 metres above sea level - and the harsh climate accounts for the high levels of chronic tonsillitis among children. But Dr Bergali's team also collected information about villagers' attitudes towards mental health. Each family who came for a check up was asked whether they knew what mental illness was, what they thought caused it and whether they had relations with mental health problems. Their answers were noted down in a pre-prepared questionnaire. It is not Dr Bergali's job to analyse the data from the 1,600 questionnaires filled. But what he has heard does not surprise him. "Awareness of mental illness is very low," he said. "Very few people know there are doctors specialised in mental health. When we asked who a family would visit if one of their members was suffering from mental problems, the two commonest answers were 'a surgeon' or 'the local imam'." On the plus side, he added, mental health problems appeared to be relatively infrequent in Baradost, like most other rural regions. "It is in the solitude of cities that people have most difficulties," Dr Bergali added.