Dar al-Ajaza hospital, like many of its patients, is no stranger to war. Situated not half a mile from the Sabra and Shatila camps in the neighborhood of Tariq al-Jadideh, this unfortunately positioned hospital has been subject to damage from artillery shells, phosphorus explosives, canon bombs, fire and demolition; its buildings have been destroyed and rebuilt, evacuated and renovated many times.
Lebanon has no problem repairing physical damage and the hospital bears no scars of its violent past; it is the unseen remnants of war however, which the hospital now works to heal. Established in the early 1950s to house the disabled and old aged of Beirut, Dar al-Ajaza now serves as a neuro-psychiatric hospital for the treatment of mental and nervous disorders, in addition to its original purpose as a home for the elderly. At the outset of the Lebanese civil war in 1975 and 1976, the hospital was hit repeatedly by artillery shells.
During the 1982 Israeli invasion the entirety of the children’s ward was destroyed, killing 12 people and injuring 32. The War of the Camps in 1985, between the Amal Movement and Palestinian groups, destroyed much of the hospital, including the pharmacy, the laboratory and precious equipment. The history of Dar al-Ajaza provides a fitting analogy for Lebanon; violence and uncertainty have clouded its past. Dr Jamal Hafez, the head of psychiatry at the hospital, explains that it is this uncertainty which causes the hospital’s most common disorder: “Social instability is a main cause of mental disorders in Lebanon.
“The Lebanese don’t really know what will happen in one year. Anxiety means a feeling of imminent danger of unknown origin. It means that we will never know what will happen. This is anxiety. Our life in Lebanon is based on anxiety as a mental disorder, not as an emotion.”
What effect does war have on people’s mental health? “War is a very small word, [but] it means many things,” says Dr Hafez, seemingly keen to stress that it is not just the act of war itself, but the variety of related effects that cause mental health problems. “It means loss of economy, loss of interest in life, loss of credibility of their nation, loss of giving people what they need. The whole issue makes the human being lose his dignity,” he adds.
Dar al-Ajaza is home to around 400 inpatients, approximately 300 of whom are long-term patients suffering from a range of disorders, with anxiety, depression, schizophrenia and psychosis being the most common. Forty percent of the hospital’s funding comes from the Ministry of Health and United Nations Relief and Works Agency (UNRWA); the rest is paid for by charitable donations from individuals throughout Lebanon and the Gulf, as well as from businesses and other organizations.
The hospital is well-equipped, immaculate and well-staffed. The smell of fresh paint is overpowering in a ward being redecorated, all paid for by a single donation from a wealthy benefactor.
While the hospital’s administration seems to be adept at soliciting funding for its work, paying for treatment of mental disorders is a serious problem faced by Lebanese. Many are unable to afford treatment for mental health problems, as coverage for treatment is absent from most insurance policies.
Not receiving proper care, says Dr Hafez, has drastic consequences. “If somebody is suffering from depression, there is a great possibility that he will commit suicide if he doesn’t receive treatment. Some insurance covers psychiatric illnesses, but if (people) can’t afford it they suffer,” he said.
Dr Hafez emphasized the need for more attention to be paid to mental health issues by the state. “If you talk to someone in our Ministry of Health, they might tell you that mental health is not really a priority, this is understandable given various factors. But we cannot make a healthy society, without a healthy mental society.”
What is required, says Dr Hafez, is not just funding, but a serious effort to teach people about mental health issues so they know when to seek professional help. He downplayed the idea that people in Lebanon suffer from a “social taboo” about mental health, meaning a disinclination to seek out assistance. In his view, it’s not mistaken ideas, but not enough information, that should be blamed.
“We need to explain to the whole society, what mental health means, what schizophrenia means, what depression means, what psychosis means. We have to urge people to listen to the professionals, to explain to them when you really have to seek help from psychiatrists.
“On the other hand we have many doctors, good doctors in Lebanon, and medication. People need to be educated on these issues,” Dr Hafez said.