A modest family means that they can hardly make ends meet, and find themselves unable to get access to medical care to diagnose their siblings’ medical conditions, let alone find out how they developed in them in the first place, noting that this disorder affected their siblings in early childhood hindering their abilities to stand, walk, and express their feelings.
Hammado lives in Hanbushiyeh, a village located in the countryside of Jisr al-Shughur District, Idlib, northern Syria. She is worried that her adult siblings might contract the virus, since they spend most of the day outdoors and come home in the evening. According to her, they know it is time to return home when they feel hungry, but the news of the coronavirus outbreak has raised her concerns, and disrupted her plans. “We are worried about their health more than ours. I have taught them how to clean themselves, what and how to eat,” explains Hammado.
It is worth mentioning that Hammado communicates with her siblings through words and gestures, as well as repeating her words more than once, so that they would understand her and carry out what she told them to do. The spread of the virus across the world, and the fear of its outbreak in Syria with its deteriorating medical conditions, and the destruction of its infrastructure, are all factors that add salt to the wounds of a vulnerable sector of Syrians, namely, those with mental disabilities. Most of them are young people with ages ranging between 18-35 years old, who are unfortunately suffering in despair, as they fail to attract the attention of social and medical services providers. Hence, their burden rests solely on their relatives amid an acute shortage of aid facilities to combat the epidemic.
“Unfortunately, people with special needs and mental disabilities have no access to medical facilities to save them from being infected,” commented the head of a treatment and psychological support center based in the countryside of Aleppo.
With the COVID-19 outbreak, specialists and doctors have repeatedly reported a surge in levels of violence against people of special needs, which leaves them in a very vulnerable situation and exacerbates their sufferings, according to the facts revealed in this report.
One of the challenges faced by disabled people, including those with a mental disability, mental illness, and others who have psychological and mental disorders, is the flawed laws concerning their conditions. Some cases aren’t necessarily a mental disorder, but legal texts occasionally use inadequate medical terms, resulting in a confusion between mental incapacities and psychological disorders. For example, the Syrian Personal Status Law stipulates that “a madman is fully incapacitated. In other words, all his actions shall be deemed null and void. He has no free will and all his actions are illegal, namely, buying and selling.”
Rahada Abdoush, a Lawyer from Damascus, pointed out that the current legal texts were drafted in the 1950s, and contain outdated terms that must be changed, such as the phrase “insane” and “imbecile.” Therefore in court, deciding on a matter, in practice, depends on the medical expert report. “The law does not determine the nature of the mental illness, but the medical expert report does. It distinguishes between the incompetent, the simpleton, the mentally ill, and the insane. It identifies all sorts of mental incapacities, as well as defining the aim of the law, the competence of a patient to manage his possessions and control his actions, and determines whether he needs a guardian and a curator. It also predicts the duration of his/her custody whether it is permanent or for a limited time,” Abdoush tells Daraj.
As of 2016, more than 10 thousand people were interdicted of their legal capacity in the five years that past, due to their incapacity and mental abnormality that were deemed to be “insane” or “imbecile,” according to Mahmoud al-Marawi, the first sharia court judge in Damascus, and according to the current legal characterization in Syria.
“To interdict a mentally disabled person of his legal capacity as well as the seizure of his money, upon the request of one of his relatives, the patient must undergo a medical examination that confirms his mental disorder,” explains the lawful judge.
It’s worth mentioning that no such cases of coronavirus have been reported, neither in other Syrian regions under the control of the opposition, Northern Syria, or in the Autonomous Administration of East Syria.
However, the Crnic institute has recently published a study in the scientific journal Nature revealing that Down syndrome patients are more susceptible to autoimmune diseases, and therefore more likely to be infected with COVID-19.
Acute Shortage of Doctors
The situation of those who are mentally challenged has become increasingly complicated, with an acute shortage of specialist doctors and care centres. Doctor scarcity rates have surged, and the medical centres’ readiness for treatment and diagnosis have decreased as a result of the conflict. The official figures have estimated that the number of psychologists in Syria is only around 70 psychologists, which would cover around 9% of the needs. “There are three doctors for every one million people, while the acceptable global rate is one doctor for every 10,000 people,” explains Dr. Mazen Haydar, President of the Syrian Association of Psychiatrists.
During her long working day from the morning until late at night, Maha Jawad, the Psychiatry specialist, who works at “Al-Nafs Al-Mutmainnah” centre, an affiliate of the Syrian American Medical Society, SAMS, in Al-Dana village in Aleppo’s rural areas, raises awareness about the necessity of preventing their relatives and family members who suffer from mental disabilities and psychiatric disorders from participating in gatherings because their susceptibility of contracting the virus is higher than others, due to the lack of sufficient information to face the pandemic .
The employees working in the centre, which provides services in the field of mental illness and chronic diseases for nearly 4,000 persons varying between existing and new cases, are currently reinforcing health awareness to patients and their families on personal hygiene, sanitization and regular hand washing, in light of the outbreak of the COVID-19 pandemic. Muhammad Bassam Abdul-Kareem (17 years), is among the patients regularly visiting the centre to receive medical services and counseling. According to his father (Bassam), the young man suffers from physical and mental disabilities, and often endures painful convulsions and seizures.
Muhammad lives with his family in the Hazano region in Idlib’s countryside. These days, his father is mainly concerned about the fear of the spread of the pandemic following its outbreak in Syria, and the lack of tranquilizers and neurological medications in the region. Even if they were to be available they were often overpriced.
“We suffer from the lack of medicine, and we must be very cautious with our son, we give him disinfectants and face masks, and we prevent him from being exposed to others to protect his health,” explains Bassam.
One of the doctors in Idlib has noted that the Sharia Court in Damascus reported that ‘insanity’ and ‘imbecile’ cases, which are the terms that the Syrian law uses to refer to people with mental disabilities, account for 50 cases only in Idlib governorate in 2014, 250 cases in Aleppo and around 3,000 cases all around Syria. He added that it has recently become hard to count the cases due to the repetitive displacement and intermittent military attacks that hinder the work of specialised organisations and medical centres.
According to the agreement on the rights of people with disabilities ratified by Syria, the state should be committed to provide people with disabilities with forms of human aid. The official website of the Syrian ministry of health has estimated that the number of beneficiaries of mental health services in 2019 amounted to 135,242 people.
One Quarter of the Village Residents are “Disabled”
Mariam complains about everything, starting from the lack of social and medical support to her four brothers, and the lack of support for people with mental disability in general, to the fact that no one is helping them in facing COVID-19, to the family’s weak purchasing power. She noted that her family needs 2500 to 3000 Syrian liras per day ( US$ 1) only to buy bread, given that 1 kg of bulgur wheat costs 1,000 liras and 1kg of lentils costs 1,300 liras.
Shaker Abdou, the local council representative in “Al-Hanbousheh” village in Jisr Al-Shaghour countryside, stressed that the council is unable to provide aid or support for disabled people due to the lack of support by humanitarian organisations, the lack of expertise and the absence of medical centres in the village. The local council official has estimated that the number of disabled people in the village accounts for 25% of the residents, around one quarter of the village residents. This is attributed to the frequent marriage among relatives, which often complicates the situation further. This reality has affected Mariam, and people like her, as she tries hard to protect her siblings from contracting the Coronavirus, even though she also suffers from a disability in her right foot as a result of around 9 surgeries to be able to walk on her feet again.
Fear of the Unknown
Not only do the special needs people living in northern Syria not receive adequate support and aid, but also those in other regions, particularly areas that have been witnessing military action and airstrikes in eastern Syria during the battles against ISIS.
Continuous cleaning and the fear of infection of people with mental disabilities and those with fragile physical structures, compel the mother of the young Khedr Issa, 30 years, from the village of Qara Qoy, a town of Darbasiyah in Hasakah, to be close to him day and night.
Young Khedr, registered with the Directorate of Social Affairs and Labor in Hasakah, as a person who is suffering from mental retardation, with deformities in the head and eye, needs a caregiver, and has not received any official assistance. No one has ever inquired about his health status before, neither during quarantine periods, nor during the peak global spread of the disease, nor after the spread of the virus in Syria.
His mother is fully in charge of taking care of his health, and protecting him from the pandemic, despite her severe poverty status.
“We have not received help from anyone,” she says, sitting in her rural home’s court, “He washes his hands daily with soap, I don’t allow him to go out and mix. I have been taking care of him since he was a young boy. I don’t know who will take care of him when I am gone… I love him a lot.”
On the other hand, some medical centers in the Hasakah region provide services, in the fields of educational support and child protection, including the “Smart” Center in al-Qamishli, established in 2012 and with projects extending to al-Hasakah, Deir al-Zour, and Raqqa. As the Coronavirus epidemic began to spread, there were no plans to target people with mental disabilities with awareness programs, according to the psychologist and director of the center, Mohammad Ali Uthman.
“There is no special support for people with disabilities to protect them against COVID-19, the projects are related to education and child protection, but we are working on spreading awareness and printing posters for prevention,” he added. Safety instructions targeting about 500 people, including children, include maintaining social distancing, at a distance of at least one meter, disinfection, as well as wearing gloves and masks.
Violence During Coronavirus
People with special mental needs are living with the consequences of COVID-19, whether they are adults or children, a large part of them remaining home to avoid mixing, according to the director of the Smart Medical Center.
Staying at home can be a positive factor, protecting them against the disease, and against being affected by other factors, such as violence towards them; for specialists began to record levels of violence against them during the Coronavirus pandemic in Syria. This was demonstrated by the results of a questionnaire prepared by the Syria Bright Future (SBF) foundation for psychiatric health, social support, and protection, to measure levels of violence toward people with special needs, and the levels at which they have access to adequate information about COVID-19 in Syria.
The survey revealed, according to psychiatry consultant Mohamed Abu-Hilal (44 years old), that 20% of the respondents believe that “there is an increase in violence against people with disabilities during this period, and that 25% of those who answered the questionnaire believe that people with disabilities do not have sufficient information about the disease.”
“Violence has increased in general because of increased friction among people throughout the day, and due to the stressful atmosphere affecting families and special needs people, and thus the ability to understand their behavior has declined,” he explained.
Moreover, a report concerned with psychological and social support during the period of Coronavirus, issued by IASC-Inter Agency Standing Committee, shows that disabled people face obstacles during the spread of COVID-19, such as the cost of health care that limits their access to services, as well as prejudices, stigma and discrimination against them, including the belief that they cannot contribute to the response to the outbreak of the Coronavirus. This leaves them and their caregivers with additional pressure.
In Syria, the Coronavirus pandemic has been putting additional weight on an already-exhausted people, and the more fragile segments seem to be forgotten models of daily Syrian suffering.
- This report was prepared under the supervision of the Syrian Investigative Journalism Unit (Siraj).