I couldn’t take my eyes off this haunting photo by Joao Silva on the front page of the October 10, 2007 NY Times. A young boy is looking inside a bloodied white Oldsmobile that was riddled with bullets from automatic weapons fired by private security guards.

Boy looking at bloodied car in Iraq

We are not told whether the boy knew or was related to the victims, both women. One was a 59-year-old mother of three grown daughters; the other, her 30-year-old passenger. A woman and a boy who were in the backseat survived. We don’t know if this is that boy, but we can be fairly certain from expression on this youngster’s face, that this is a life-changing event for him. He will not be the same little boy, after this witnessing this horrific scene, as he was before.

 

Mental health disorders in children in Mosul

My speculation about this boy’s future is supported by an article in the October 2, 2007 issue of BMC Public Health. The authors, Asma Al-Jawadi and Shatha Abdul-Rhma, assessed 3079 children from families who attended primary health care institutions in Mosul, Iraq and found mental disorders in more than one-third of the children. Let me repeat that, more than one-third of children were found to have mental disorders.

Here are the details of the study. Mothers who came to the primary health centers in Mosul for vaccination of one of her children were included in a systematic sampling randomization. All children of these mothers (ages 1-15 years old) were considered in the interview and examinations. 3079 children were assessed. 1152 were diagnosed with a childhood mental disorder for a point prevalence of 37.4%. The ratio of males to females was 1.22:1.

The top ten diagnoses among the examined children were as follows:

  • Post-traumatic stress disorder (PTSD) ( 10.5%)
  • Enuresis (bed-wetting) (6%)
  • Separation anxiety disorder (4.3%)
  • Specific phobia (3.3%)
  • Stuttering &school refusal each had a point prevalence of 3.2%
  • Learning & conduct disorders have the same figure (2.5%)
  • Stereotypic movement (2.3%)
  • Feeding disorder of infancy or early childhood (2.0%).

Overall, the highest prevalence of mental disorders was found among children 10-15 years old (49.2%). While the lowest prevalence was in 1-5-year-olds (29.1%). Boys were more afflicted than girls (40.2% & 33.2%) respectively.

 

What will the future hold?

Now that you have read this, please go back and look again at the face of the little boy in the photo. What is his future? PTSD?…probably. Acting out?…likely. Will he have problems concentrating at school?…yeah, that too. Without therapy—a scenario unlikely in war-torn Iraq—will this young boy be able learn a profession or trade and eventually make non-war-related contributions to his community and his country? Or will he be forever altered, unable to function “normally” in a “normal” society? [Is he even alive?]

These are not just potential social or political problems, rather, they are important health care challenges that have had little, if any, discussion that I have seen in the national or international media. Yet, once this war is over and Iraq enters its post-war period, mental health disorders in the population—both adults and children—will be a serious health care issue that will have to be addressed if Iraqi’s are able to build a healthy society.

Doubt the seriousness? If so, I suggest you go back and take one more look at that little boy’s eyes.

 

Post script – June 9, 2015

A more recent study of mental health in children in the war-torn Middle East titled, “A systematic review on the mental health of children and adolescents in areas of armed conflict in the Middle East,” found the prevalence of PTSD in Iraqi children and adolescents to be between 10-30%, in Palestine, 23-70%, and Israel 5-8%. It is still unclear, and perhaps understandable given the current level of violence in Iraq, that the world has not yet come to grips with the problem and what it means for the future.


Occurred during the George W. Bush Iraq War (aka Iraq War 2), but given what is going on there now, it is, unfortunately, just as applicable today.

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