In this country, in this city, in this hospital, where the danger has driven the doctors away, Mohammad Rashid is as much patient as psychiatrist.
"It takes more than two hours daily to come from my place to the hospital. And the road, I see many scenes, I face many confrontations with the guards, with the American soldiers," says Rashid, one of four psychiatrists practicing at Baghdad's Ibn Rushid hospital. "I have the same worries about my children when they go to their school — I call my wife three or four times daily just to reassure that they came back safely. So it's not easy. We are fighting. We are fighting to live."
He didn't always have to fight like this. It wasn't always that Ibn Rushid had no psychologists. It wasn't always that the psychiatrists were so busy they couldn't spend more than five minutes with each patient. It wasn't always that doctors had only enough drugs to fill two weeks worth of a prescription.
And it wasn't always that electroconvulsive therapy, better known as shock therapy, was delivered without any anesthesia.
Years ago, before the wars and the sanctions, full teams of doctors trolled these halls, caring for the acutely depressed, the suicidal, the ones who couldn't cope with life. Patients would come from all over Iraq, and the pharmacy was relatively full.
But today, Ibn Rushid has little money or staff. It has a shortage of drugs. And it has zero anesthesiologists. Which means the worst patients — the ones who don't reply to medicine, the ones whose depression responds only to electric shocks — are forced to endure a treatment that, while ultimately helpful, is considered barbaric. The World Health Organization has called for a worldwide ban on shock treatment without anesthesia, but it is practiced multiple times every day here.
"The problem is with the human resources," Rashid says, standing over the anesthesia machine that hasn't been used in months. A few feet away, the electrodes that send electricity through patients bodies are used dozens of time per week. The problem is not, he says, with the equipment.
"It's fair enough. It can give anesthesia. But because of the shortage…" he trails off, shrugging his shoulders as he walks away.
Like so many of the learned parts of this city, this hospital suffers from a brain drain caused by fear. And it suffers from an economic shortage caused by a government unwilling or unable to make psychiatry a priority.
Today, fewer than 10 psychiatrists work in the capital of around 7 million people. A few years ago, the number was closer to 50.
"This," Rashid says, "is our destiny."
Ibn Rushid's courtyard garden is well maintained, and the doctors and the patients say they don't fear coming here, at least not now, although sometimes they can't reach work because of violence. Much of this city is safer than it was one year ago, thanks to U.S. counterinsurgency efforts and Iraqi government deals with the militants.
But ask the doctors, and they'll hint at an intimidation campaign that once stalked them like nightmares. Ask them what the hospital was once able to do, what it is incapable of doing today, and they'll sigh about the current state of Iraq.
"The effect of war is very dramatic here," says Rashid, who is also the chairman of the Iraqi Psychiatric Society. "Most of the patients, the depressed patients, the anxious patients, have stories of war or losing an important person."