Away from the media spotlight, Iraqis with mental health problems have suffered under sanctions and now face fresh complications.
For almost a quarter of a century Iraqis have faced conflict: a bloody war with neighbouring Iran from 1980 until 1988: a US-led international coalition bombardment to oust Iraqi troops from Kuwait a few years later; thirteen years of crippling UN-imposed sanctions. And now occupation soldiers patrolling Baghdad.
This is all well documented. What remains more sketchy is the toll this has inflicted on the mental health of the nation.
A steady stream of visitors flows in and out of Dr Naaman Sarhan Ali's office in Baghdad's Ibn Rushd Psychiatric Hospital.
A scrawny man shuffles in and eagerly asks the consultant psychiatrist to write him his prescriptions for the month, which include two tranquillisers and an anti-psychotic.
"Twenty-five per cent of Iraqis suffer from psychological illnesses or disturbances," said the consultant psychiatrist, who has been practicing in the country for 20 years.
Ali, who is also the secretary-general of the Iraqi Society of Psychiatrists, says his estimate is based on observations and that he has so far been unable to conduct a large-scale study.
Ali has noted an increase in depression and anxiety-related behavioural disorders.
"Iraq is a multiple wounded nation,” he says.
"We are not talking about one disaster. When people - and America - talk about 9/11, it is one disaster they have been talking about for three years. But there are ten to 15 9/11s that happened to this country."
One of the most devastating blows to Iraqis was the United Nations-imposed sanctions.
"The sanctions have affected people, not the regime. If those who had imposed the sanctions had any mercy, they would have lifted them a long time ago. They have made people suffer endlessly," he said.
The hospital administers electroconvulsive therapy (ECT) to patients deemed as highly suicidal or who are paranoid schizophrenics refusing to take medication or food. ECT sends electric shocks through the brain to induce controlled seizures.
The busy Ibn Rushd Psychiatric
Hospital in Baghdad
"We use it as a life-saving measure when we feel there is a threat to the patient or a threat to others," says Ali.
"Ideally we should use anaesthesia. But because of the sanctions we could not get anaesthetic agents," he said. All doctors could do under sanctions was offer an injection to make patients less anxious.
"We are still doing it without anaesthesia," he said.
Patients with schizophrenia, psychosis and bi-polar depression suffered more during the war.
"They suffered a great deal because they could not get their medication," says Ali. "They were not seen by a psychiatrist and their conditions got worse because of the additional trauma.
"Some schizophrenic patients would feel that they were being followed by the Americans, by the security agencies and their phone calls were tapped," he added.
More war wounds
Over the past year, Ali has also seen a hike in acute stress reactions, which include anxiety, poor sleep, nightmares and headaches.
Most of these symptoms disappear within a few months, but if they persist they can develop into post-traumatic stress disorder (PTSD).
However, PTSD may surface 10 to 20 years after the traumatic incident, particularly in children, he warned. Patients need to be able to talk and cry freely about the war, or disorders will develop. But family support - a vital element in Arab society - can prevent the development of chronic PTSD, he stressed.
And Iraqis have learned to adapt to major disasters.
"You go into one trauma and then you move on to another before the wounds of the previous one are cleared. If the problems that Iraqis have gone through took place in America or Europe, half their population would be dead," claims Ali.
Despite the increase of depression, there has not been a rise in suicide. Ali attributes this to Iraq's Arab and mainly Muslim society, where family ties, honour and religion prevent patients from killing themselves.
Stigma is attached to a family where a relative has committed suicide. In the case of females, this stigma can sometimes endure for generations, he said.
"I have asked some of them (suicidal patients) what prevented them from doing it and they say, 'I either think of my family or it is haram (forbidden)'," said Ali.
"People don't talk about mental illnesses because there is still a stigma attached to it"
Dr Naaman Sarhan Ali,
In the absence of national mental health services, family ties also provide a network for healing.
"The social network in Arab countries replaces or offers most of the services that would be provided by social services. The family takes the patients and cares for them. They do a great job in supporting the patients," he added.
Yet, in Arab societies, mental illnesses are still a taboo. "People don't talk about mental illness because there is still a stigma attached to it," he said.
However, people do want to talk about the wars and sanctions, he said.
Ali has concerns for the future mental health of Iraqis. Employees in this field need to be updated on the latest research, he said, stressing medication is not the only solution to their problems.
The health ministry has put mental health high on its agenda. Before the occupation, admission to Ibn Rushd, with a capacity of 75 beds, would cost 5000 dinars or about $4 a day. Today it is free. A consultation, examination, medication and laboratory tests cost 500 dinars or 40 US cents.
"There is something that people in the West don't understand and that is the resilience of this society," said Ali.