The Daily Star
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BURJ AL-BARAJNEH, Lebanon: It’s symptomatic of disorders of the mind that they are intensely personal. Left locked inside the brain, problems such as depression and anxiety can become debilitating – yet many sufferers are loath to talk about them.
But sooner or later, many people reach a breaking point. For “Samar,” a 42-year-old woman from the Bekaa Valley who does not want to publish her real name, that point was 10 months ago. “I wanted to commit suicide,” she says. “I was tired of life and no longer had any ambitions that I wanted to live for.”
So when Samar’s sister heard of a mental health clinic run by Medecins Sans Frontieres near the Burj al-Barajneh refugee camp, she says that despite the fact that others had warned her off therapy, “I wasn’t scared to go at all. I wanted to get better.”
Neither UNRWA nor the Ministry of Health offer mental health care. In January 2009, MSF opened a center outside the Burj al-Barajneh refugee camp to fill this gap, for both Palestinian refugees and Lebanese who can’t afford private health care. Psychologists, psychiatrists, social workers, nurses, and outreach personnel – who are mostly Lebanese or Palestinian themselves – recruit, treat, and follow up on patients, free of charge.
Patients are treated in MSF’s original center, a well manicured house outside the camp, or inside the less picturesque Haifa Hospital and UNRWA clinic.
The fact that Samar was steered away from psychology is not unusual. Mohammad al-Hashash, a psychiatrist who works with MSF and has a private practice in Beirut, says that with mental health issues, “stigma is a problem you face everywhere. It is not specific to this place … But if people have a need, even if they deny it,” they are likely to eventually seek treatment.
Hashash says that since he and the other doctors became known in the community, patient numbers have increased. “Lately, I’ve been overbooked,” he says. “Sometimes a patient comes in, I finish with the patient and I find another patient waiting to get in.”
MSF has seen some 1,500 patients.
The most common diagnoses are anxiety and depression. Hashash says that the mental health problems in the camp and the nearby area reflect those of the country’s population, but have different manifestations.
“Outside there is anxiety,” he says. This anxiety is often “about getting sick … worries about work, worries about losing money.”
Because of “the crowding in the camp, the main thing that you find many people complaining about is that they don’t have their personal space,” Hashash says. “Sometimes you find people living in a small space all together. If they talk they might be heard by their neighbors … many of the patients feel confined.”
The majority of patients are women. Stephanie al-Hajj, an MSF psychologist, says this is not surprising, as generally “women come more to psychologists. They speak more about their problems.”
At MSF, some men may be unable to attend the clinics’ daytime hours because of work. Hajj says that she thinks the stigma surrounding mental health may also be stronger for men in the area, who are “expected to be strong” and perhaps “would prefer to go speak to a … religious figure” than a psychologist.
Hajj says the women she sees are looking for help to deal with, among other issues, marital problems, domestic violence, religious issues, body image, and a lack of self-confidence.
Seven years ago, UNRWA’s lone psychiatrist in Burj al-Barajneh ceased work, leaving some patients heavily medicated with no follow-up care. One MSF psychiatric nurse says she found these patients “in very bad shape.”
MSF is also set to finish its three year program at the beginning of 2012. Stephanie Giandonato, the project’s field coordinator, says MSF is currently discussing a handover with both UNRWA and the Burj al-Barajneh municipality. In April, MSF began a similar program in Ain al-Hilweh.
For now at least, the women, and some men, of Burj al-Barajneh – or in Samar’s case, all the way from the Bekaa – have some relief. Samar now takes medicine and sees a therapist once a month. “I’m very happy, she says. “I’m feeling much better.”
In a population once shy about mental health, the doctors say that most referrals now come from family, friends and neighbors. For her part, Samar says she is “trying to help others and tell them about the center … because I know that there are a lot of people with my condition, and worse, in our society.”
But sooner or later, many people reach a breaking point. For “Samar,” a 42-year-old woman from the Bekaa Valley who does not want to publish her real name, that point was 10 months ago. “I wanted to commit suicide,” she says. “I was tired of life and no longer had any ambitions that I wanted to live for.”
So when Samar’s sister heard of a mental health clinic run by Medecins Sans Frontieres near the Burj al-Barajneh refugee camp, she says that despite the fact that others had warned her off therapy, “I wasn’t scared to go at all. I wanted to get better.”
Neither UNRWA nor the Ministry of Health offer mental health care. In January 2009, MSF opened a center outside the Burj al-Barajneh refugee camp to fill this gap, for both Palestinian refugees and Lebanese who can’t afford private health care. Psychologists, psychiatrists, social workers, nurses, and outreach personnel – who are mostly Lebanese or Palestinian themselves – recruit, treat, and follow up on patients, free of charge.
Patients are treated in MSF’s original center, a well manicured house outside the camp, or inside the less picturesque Haifa Hospital and UNRWA clinic.
The fact that Samar was steered away from psychology is not unusual. Mohammad al-Hashash, a psychiatrist who works with MSF and has a private practice in Beirut, says that with mental health issues, “stigma is a problem you face everywhere. It is not specific to this place … But if people have a need, even if they deny it,” they are likely to eventually seek treatment.
Hashash says that since he and the other doctors became known in the community, patient numbers have increased. “Lately, I’ve been overbooked,” he says. “Sometimes a patient comes in, I finish with the patient and I find another patient waiting to get in.”
MSF has seen some 1,500 patients.
The most common diagnoses are anxiety and depression. Hashash says that the mental health problems in the camp and the nearby area reflect those of the country’s population, but have different manifestations.
“Outside there is anxiety,” he says. This anxiety is often “about getting sick … worries about work, worries about losing money.”
Because of “the crowding in the camp, the main thing that you find many people complaining about is that they don’t have their personal space,” Hashash says. “Sometimes you find people living in a small space all together. If they talk they might be heard by their neighbors … many of the patients feel confined.”
The majority of patients are women. Stephanie al-Hajj, an MSF psychologist, says this is not surprising, as generally “women come more to psychologists. They speak more about their problems.”
At MSF, some men may be unable to attend the clinics’ daytime hours because of work. Hajj says that she thinks the stigma surrounding mental health may also be stronger for men in the area, who are “expected to be strong” and perhaps “would prefer to go speak to a … religious figure” than a psychologist.
Hajj says the women she sees are looking for help to deal with, among other issues, marital problems, domestic violence, religious issues, body image, and a lack of self-confidence.
Seven years ago, UNRWA’s lone psychiatrist in Burj al-Barajneh ceased work, leaving some patients heavily medicated with no follow-up care. One MSF psychiatric nurse says she found these patients “in very bad shape.”
MSF is also set to finish its three year program at the beginning of 2012. Stephanie Giandonato, the project’s field coordinator, says MSF is currently discussing a handover with both UNRWA and the Burj al-Barajneh municipality. In April, MSF began a similar program in Ain al-Hilweh.
For now at least, the women, and some men, of Burj al-Barajneh – or in Samar’s case, all the way from the Bekaa – have some relief. Samar now takes medicine and sees a therapist once a month. “I’m very happy, she says. “I’m feeling much better.”
In a population once shy about mental health, the doctors say that most referrals now come from family, friends and neighbors. For her part, Samar says she is “trying to help others and tell them about the center … because I know that there are a lot of people with my condition, and worse, in our society.”
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