Deep inside the meandering, narrow streets of Aleppo’s once-prized Old City, behind a door that looks like any other door, is the Dar al-‘Ajeza, the city’s hospital for the mentally disabled. One man, 31-year-old Abu Abdu, now looks after the 60 or so patients housed there.
“There’s no one else to help them,” he said. He’s been there for five years.
A dismal, gray rain dripped steadily in the central courtyard. “It’s cold, it’s cold, it’s cold,” one man repeated over and over, rocking back and forth in a wheelchair in a dark room.
Abu Abdu works without a salary now. With the collapse of government support over the months since rebels took over large swaths of Aleppo, the hospital now depends on a few charitable businessmen to keep afloat. “There’s no electricity, no bread, no medications, no doctors,” he said. The hospital’s manager still comes several times a week to check in on the residents, but otherwise Abu Abdu, a single man from another part of town, tends to their needs.
In Syria, mental disability is considered a shame for the family and kept hidden from view, even on a good day. So those with mental-health issues are especially vulnerable in times where the population at large lives under threat. Abu Abdu said that none of the families of these men have visited them since the war came to Aleppo.
He gestured towards the back room, where the “worst cases” stay.
There, 12 patients were somehow sharing four beds. Bundled up in blankets, they formed a single mass. When we arrived, one man promptly took cover under a blanket. Some of the others screeched and giggled, others made wordless moaning sounds. Several held their knees to their chests and banged their backs rhythmically against the walls.
Abu Abdu gently stroked the head of a man who lay on a bed alone, slowly chewing a white rag in his mouth, neck tendons straining.
“Sometimes they get upset,” he said. “I come in when there’s shelling to talk to them and calm them down.”
The stench of urine in the room was dense and thick. It was difficult to believe Abu Abdu’s claim that he bathed them every day.
Visitors proved a lot for the patients to take in, and when lunch arrived – giant buckets of soup – it was time for us to leave. A short man named Bakari grasped my hand and shook it, repeating the words, “Barak allahu fiq” (Arabic for “God bless you, God bless you”).
Stigma at a time of war
Treatment of mental health and developmental disabilities in the Middle East and North Africa (MENA) region is in its infancy. It is difficult, even in peacetime, to assess how many people have these disorders.
People with IQs under 70 are generally considered developmentally disabled. This includes genetic conditions such as Down syndrome and Fragile X syndrome, and also environmental factors such as lack of oxygen at birth and deficient nutrition in infancy and childhood.
Something like a violent nationwide conflict accelerates the risk and rate of diseases like depression and post-traumatic stress disorder. Non-governmental organizations working inside Syria and with fleeing refugees come across a large number of these war-related afflictions. There is so little psychiatry practiced in the MENA region that personality and mood disorders, which Western medical traditions understand to be partly chemical in nature, are almost never treated.
With so few care facilities in place in Syria and elsewhere in the region, children with these disorders tend to be kept at home, due to social stigma and lack of understanding about the disorders.
This puts a disproportionate strain on women and limits the progress that children with these disadvantages can make with medical and psychological treatment. They are rarely integrated into society and often develop secondary psychological and behavioral conditions. Meanwhile grown men and women who are sick and alone end up in places like Abu Abdu’s back room.