The psychological impact of COVID-19 pandemic on Iraqi health workers.

OBJECTIVE: To explore the psychological impact of coronavirus disease-2019 on frontline healthcare workers in Iraq. METHODS: The cross-sectional study was conducted from November 2020 to September 2021 after approval from the ethics review committee of the College of Medicine, Mustansiriyah University, Baghdad, Iraq, and comprised doctors and nurses from 4 teaching hospitals and 8 primary healthcare centres in Baghdad. Psychological sequels, like anxiety, depression, fear and insomnia, were assessed along with exposure to coronavirus disease-2019. The study questionnaire was based on the Patient Health Questionnaire Anxiety and Depression Scale. Data was analysed using SPSS 26. RESULTS: Of the 400 participants, 288(72%) were doctors and 112(28%) were nurses. Overall, 215(53.7%) subjects had had a coronavirus disease-2019 infection, 192(48%) reported having anxiety, 148(37%) fear, 100(25%) depressive symptoms, and 51(12.8%) complained of insomnia. Doctors were more likely to have anxiety than nurses (p<0.05), but the difference in terms of depression was not significant (p>0.05). CONCLUSIONS: The mental health of the frontline healthcare workers was found to have been affected by the coronavirus disease-2019 pandemic, with anxiety and fear being the main symptoms.

A profile of emergency departments in Baghdad hospitals.

OBJECTIVE: To assess the structure as well as availability of essential equipment and medicine at emergency departments in Baghdad hospitals. Method: The descriptive, cross-sectional study was conducted from March to June 2021 after approval from the ethics review committee pf the College of Medicine, Mustansiriyah University, Baghdad, Iraq, and comprised emergency departments of general and teaching hospitals in the city. Evaluations were done using the World Health Organisation checklist and the guidelines of the Australasian College for Emergency Medicine related to Emergency Department Design. Results: Of the 26 secondary care hospitals in Baghdad, 13(50%) were evaluated. Triage was not available in 8(62%) hospitals, resuscitation room in 10(77%) and waiting room in all the 13(100%). An obvious shortage of medicines and vaccines was noted in 11(85%) hospitals. Coronary care unit and intensive care unit were not close to the emergency department in 7(54%) hospitals, and liaison psychiatry and social work links were not available in all 13(100%) hospitals. CONCLUSIONS: There is a need to improve service delivery at emergency departments functioning at hospitals in Baghdad.

Cosmetic intervention among Iraqi women, prevalence and associated factors (demographic, place, and time).

OBJECTIVE: To assess the prevalence of cosmetic interventions, and the factors that instigate women to undergo such procedures. METHODS: The cross-sectional study was conducted from January to June 2021 in Baghdad, Iraq, and comprised women aged 18 years or above from 4 general hospitals, 4 health centres and 8 schools. The sample was divided into group A having subjects with experience of cosmetic interventions, and group B having those with no such exposure. Data was collected using a a questionnaire. Data was analysed using SPSS (version 25). RESULTS: Of 1113 women, 997(90%) were aged 20-40 years. There were 375(34%) women in group A and 738(66%) in group B. Within group A, Botox was the most common intervention 89(23%). Besides, 215(57%) women had the intervention in clinics, and 75(20%) had it in beauty centres. Dermatologist did the intervention in 146(39%) cases, while side effects were noted in 142(38%). Within group A, 248(66%) subjects said they would not advise their daughters or sisters to have cosmetic interventions. Age and marital status were significantly different between the study groups (p<0.05). CONCLUSIONS: Cosmetic interventions among the women studied were found to be relatively high, and Botox was the most common intervention.

Prevalence of work place violence and its impact on doctors in some Iraqi hospitals.

OBJECTIVE: To estimate the prevalence of workplace violence and its impact on doctors in hospitals. METHODS: The cross-sectional study was conducted from August 2021 to January 2022 in Baghdad and Karbala governorates of Iraq, and comprised resident doctors at a number of hospitals. Data was collected using a selfadministered questionnaire that focussed on the frequency of exposure to violence, type, source, most common time, and other details about violence as well as its impact on doctors and their careers. Data was analysed using SPSS 23. RESULTS: Of the 1,079 subjects working at 18 participating hospitals and having a mean age 30.0±5.72 years, 567(52.5%) were females and 512(47.5%) were males, while 570(52.8%) were aged <30 years and 509(47.2%) were aged >30 years. Overall, violence exposure was reported by 811(75.2%) subjects; 427(52.6%) females and 384(47.4%) males. Gender was not significantly associated with exposure to violence (p>0.05). Due to missing data, further analysis was limited to 792(97.6%) subjects who faced exposure to workplace violence. In 671(85%) cases, the assaults were nonphysical. However, 110(14%) doctors reported physical attacks and severe consequences. There were 673(85%) doctors with exposure to violence who expressed their intention to change their job, workplace, or leave the country because of violence. CONCLUSIONS: The problem of violence against Iraqi doctors was found to be highly prevalent with a seriously negative impact on the medical professionals.

Suicide and suicidality in Iraq: a systematic review.

Suicide is the third-leading cause of death globally, predominantly among youth. We aimed at reviewing the available published literature and some reports about suicide, in an attempt to unveil aspects of this mental health problem in Iraq. Articles about suicide in Arab/Middle Eastern countries were also included to compare those populations of a similar race and religion. The estimated suicide rate in Iraq is 1.7/100000 population (mostly among youth), which is still lower than in western countries. However, underreporting is the reason actual numbers are not known and many who attempt suicide do not report it and so hide their intent to die. The most common method of suicide is self-hanging, followed by firearms, self-burning, and self-poisoning. Suicide and suicidality in Iraq are on the increase even though it is believed to be underreported. Many socio-demographic, psychological and environmental factors predispose to ideation, attempts, and completed suicides despite the religious and social taboos. Young females are more represented in suicide attempts and ideation using potentially lethal methods like self-burning as a consequence of higher rates of depression, community and domestic violence. A key component in suicide prevention is improving the accessibility and quality of mental and social health care services.

Conflict-related intentional injuries in Baghdad, Iraq, 2003-2014: A modeling study and proposed method for calculating burden of injury in conflict.

BACKGROUND: Previous research has focused on the mortality associated with armed conflict as the primary measure of the population health effects of war. However, mortality only demonstrates part of the burden placed on a population by conflict. Injuries and resultant disabilities also have long-term effects on a population and are not accounted for in estimates that focus solely on mortality. Our aim was to demonstrate a new method to describe the effects of both lives lost, and years of disability generated by a given conflict, with data from the US-led 2003 invasion and subsequent occupation of Iraq. METHODS AND FINDINGS: Our data come from interviews conducted in 2014 in 900 Baghdad households containing 5,148 persons. The average household size was 5.72 persons. The majority of the population (55.8%) were between the ages of 19 and 60. Household composition was evenly divided between males and females. Household sample collection was based on methodology previously designed for surveying households in war zones. Survey questions were answered by the head of household or senior adult present. The questions included year the injury occurred, the mechanism of injury, the body parts injured, whether injury resulted in disability and, if so, the length of disability. We present this modeling study to offer an innovative methodology for measuring "years lived with disability" (YLDs) and "years of life lost" (YLLs) attributable to conflict-related intentional injuries, using the Global Burden of Disease (GBD) approach. YLDs were calculated with disability weights, and YLLs were calculated by comparing the age at death to the GBD standard life table to calculate remaining life expectancy. Calculations were also performed using Iraq-specific life expectancy for comparison. We calculated a burden of injury of 5.6 million disability-adjusted life years (DALYs) lost due to conflict-related injuries in Baghdad from 2003 to 2014. The majority of DALYs lost were attributable to YLLs, rather than YLDs, 4.99 million YLLs lost (95% uncertainty interval (UI) 3.87 million to 6.13 million) versus 616,000 YLDs lost (95% UI 399,000 to 894,000). Cause-based analysis demonstrated that more DALYs were lost to due to gunshot wounds (57%) than any other cause. Our study has several limitations. Recall bias regarding the reporting and attribution of injuries is possible. Second, we have no data past the time of the interview, so we assumed individuals with ongoing disability at the end of data collection would not recover, possibly counting more disability for injuries occurring later. Additionally, incomplete data could have led to misclassification of deaths, resulting in an underestimation of the total burden of injury. CONCLUSIONS: In this study, we propose a methodology to perform burden of disease calculations for conflict-related injuries (expressed in DALYs) in Baghdad from 2003 to 2014. We go beyond previous reports of simple mortality to assess long-term population health effects of conflict-related intentional injuries. Ongoing disability is, in cross section, a relatively small 10% of the total burden. Yet, this small proportion creates years of demands on the health system, persistent limitations in earning capacity, and continuing burdens of care provision on family members.

Women's mental health in Iraq post-conflict.

Women are the silent sufferers of war, they have higher rates of anxiety and depression after terror events than men who have been similarly exposed. In this study, we aim to explore the prevalence of anxiety, depression and suicidal thoughts/attempts among Iraqi women post-conflict. A sample of 1000 women was collected in this cross-sectional study that was conducted in Baghdad city from January through September 2020. Their mental state was addressed by assessing anxiety and depression on symptomatic basis using standard questions from the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5) scale. The results showed that the vast majority (91.1%) of the sampled women had experienced war-related trauma since 2003. Anxiety symptoms were reported by 39.7% of the women, depressive symptoms by 34.2% and suicidal thoughts/attempts by 35.8%. More than two-thirds of the women experienced difficulties in their social life and relationships. The majority of the studied women had negative expectations regarding their future and more than half of them expressed their intention to emigrate. The findings of this study indicate that anxiety, depression and suicidal thoughts/attempts are prevalent among this sample of Iraqi women post-conflict. Significant associated factors were losing a husband and having early married girls in the household.

Domestic violence in time of unrest, a sample from Iraq.

Domestic violence is a worldwide problem, and there are over a billion women who have been exposed to violence from their husband or male partner. In Iraq, since the 2003 invasion, domestic violence has risen dramatically. In this study we aim to estimate the prevalence of domestic violence against women (and some associated factors) in Baghdad city. A sample of 735 women was collected from the attendants of the outpatients-Obstetrics/Gynaecology clinics of four randomly chosen health facilities located on either side of Baghdad city. A questionnaire form was developed to enquire about the occurrence of violence, its frequency, source, and reasons. The results showed that 81.2% of the women were exposed to violence (100% verbal/emotional and 39.18% physical), usually by the husband (41.4%) or brother (20.4%), mostly attributed to a stressful life of unrest (41.9%). Older and currently married women are significantly more exposed to domestic violence (p = 0.001 & 0.004, respectively). Consanguinity was associated with less violence (p = 0.0001) as was higher education (p = 0.001), employment (p = 0.044) and women's independence (p = 0.044). A stressful life of unrest was significantly associated with all types of violence (p < 0.001).

Violence against health-care workers in a conflict affected city.

The problem of aggression towards health care staff is global. It negatively impacts on their psychological and physical well-being, and on their performance. This study was set to explore the exposure of healthcare personnel to different forms of violence and the influence of this violence on their work and life. A sample of 700 healthcare workers was collected from six major hospitals and 20 primary health care centers in Baghdad. The questionnaire inquired about exposure to any sort of violence including insult, assaults, and displacement, being arrested, kidnapped, and intentionally injured or threatened at the workplace. More than 85% of respondents reported exposure to violence. The most important reason for violence was the poor medical services and lack of hospital supplies (22.1%). Young doctors were significantly more exposed to violence, especially verbal, mostly during the day. A significant association was seen between exposure to physical violence, male gender and short duration of experience. The most significant source of violence was the patient's relatives.  There is an overwhelming surge of violence against health workers that may adversely reflect on their performance. Passing legislation that protects health workers against violence is an urgent need at this time of unrest.

War or health: a four-decade armed conflict in Iraq.

Iraq has suffered 40 years of continual conflict, with large-scale traumatic events including successive wars, economic sanctions, sectarian conflict, terrorism, and organized crime. Population health and the health systems and other services and infrastructure that support a population's health usually suffer severe consequences in conflict-affect countries and Iraq has been no exception. In this article we aim to provide a historical narrative of the four decades of successive wars in Iraq and present some of the consequences of this particular situation of persistent violence and how it has reflected on the health status of the Iraqi people, as indicated by increasing morbidity, mortality, injuries, mental health problems and displacement. Continutation of the current situation of insecurity is anathema for health as war and health can never be compatible, it is a choice between war or health.

Accidents in Iraq during the period of conflict (2003-2016).

Background: Injuries are increasingly recognized as a major component of the global burden of disease, as they tend to affect mainly youth and are usually followed by premature death or severe disability. The longstanding conflict in Iraq has resulted in a situation of continuous violence and ongoing instability, which has in turn led to an increasing incidence of injuries and a crippled health system. Objective: To sketch a trend of non-military accidents in Iraq (road traffic accidents [RTA], falls, burns, firearm injuries, assaults by sharp objects and sexual assaults) among civilians during the last 14 years associated with the period of conflict (2003-2016). Methods: This descriptive study was conducted during the period from January 1st through to December 31st, 2017 using already available surveillance data from the Ministry of Health in Iraq. The methodology was based on measuring the incidence of each accident for the period from 2003 through 2016 and plotting it against time. Linear regression was computed to estimate the trends of the disease. Results: The rate of RTAs significantly increased between 2003 and 2016, from 1.85 to 2.9 per 1000 (p ≤ 0.01), as did accidental falls especially after 2008 (males more than females) (p ≤ 0.01). By contrast, after a peak in 2011, burns dropped significantly from 4.19 to 3.42/1000, along with firearm accidents, which fell from 2.2/1000 in 2007 to 0.39 in 2016 (p ≤ 0.01), mostly among males. Assaults with sharp objects also decreased with time to a rate of 0.47/1000 (p = 0.0001). Sexual assaults showed a significant downward sloping trend over time to p = 0.037. Conclusion: Accidents still add a burden on the already deteriorated Iraqi health system. Understanding the impact of this burden is essential to better prepare for future plans and interventions that may help improve the quality of health services.

Faith healers are taking over the role of psychiatrists in Iraq.

Background: Due to lack of education and awareness, faith healing has become a popular way of treating psychiatric patients. Objective: To ascertain the role of faith healers in the treatment of psychiatric illnesses by exploring the percentage of patients attending those healers. Methods: A semi-structured questionnaire was applied through a direct face-to-face interview with the patients and their companions; it inquired whether the patient has ever visited faith healers, the method of treatment the patients were subjected to, and their opinion about the benefit they got regarding improvement in their condition. Results: Among the total 482 cases; 279 (57%) reported going to faith healers (FHs) at any time before, during, or after a psychiatric consultation. Of those, 84.6% reported visiting FHs less than 10 times, while 15.4% went 10 times or more; 36.9% still believe that the treatment of FHs is accepted or even good (21.5%), while 30.9% realized that it is useless, and 10.7% think it is bad. No association was found between going to FHs and patient age or gender, while there was a significant association with marital status (p < 0.02) and with education (p < 0.001). Patients with schizophrenia/psychosis or bipolar disorders visited FHs significantly more often than those with other diagnoses. Conclusion: Faith healing is prevalent in Iraq and FHs may overwhelm the role of psychiatrists in treating mental illnesses. Sincere efforts are needed to help build public awareness and to improve accessibility and utilization of mental health services for this vulnerable group.

Injury and death during the ISIS occupation of Mosul and its liberation: Results from a 40-cluster household survey.

BACKGROUND: Measurement of mortality and injury in conflict situations presents many challenges compared with stable situations. However, providing information is important to assess the impact of conflict on populations and to estimate humanitarian needs, both in the immediate and longer term. Mosul, Iraq's second largest city, was overrun by fighters of the Islamic State of Iraq and Syria (ISIS) on June 4, 2014. In this study, we conducted household surveys to measure reported deaths, injuries, and kidnappings in Mosul, Iraq, both during the occupation of the city by fighters of ISIS and the months of Iraqi military action known as the liberation. METHODS AND FINDINGS: Mosul was overrun by ISIS forces on June 4, 2014, and was under exclusive ISIS control for 29 months. The military offensive by Iraqi forces, supported by coalition artillery and airstrikes, began on October 17, 2016, in east Mosul and concluded in west Mosul with the defeat of ISIS on June 29, 2017. We conducted a 40-cluster population-based survey as soon as the security forces permitted access for the survey team. The objective of the survey was to measure reported deaths, injuries, and kidnappings in Mosul households during 29 months of ISIS-exclusive control (June 2014-October 2016) and the nine months of Iraqi military action known as the liberation (October 2016-June 2017). In east Mosul, the survey was conducted from March 23 to March 31, 2017, and in west Mosul from July 18 to July 31, 2017. Sampling was based on pre-ISIS population distribution, with revisions made following the extensive destruction in west Mosul. The 1,202 sampled households included 7,559 persons: 4,867 in east Mosul and 2,692 in west Mosul. No households declined to participate. During the time from June 4, 2014, to the time of the survey, there were 628 deaths reported from the sampled households, of which 505 were due to intentional violence, a mortality rate of 2.09 deaths per 1,000 person-months. Over the entire time period, the group with the highest mortality rates from intentional violence was adults aged 20 to 39: 1.69 deaths per 1,000 person-months among women and 3.55 among men. In the 29 months of ISIS-exclusive control, mortality rates among all males were 0.71 reported deaths per 1,000 person-months and for all females were 0.50 deaths per 1,000 person-months. During the nine months of the military liberation, the mortality rates jumped to 13.36 deaths per 1,000 person-months for males and 8.33 for females. The increase was particularly dramatic in west Mosul. The leading cause of reported deaths from intentional violence was airstrikes-accounting for 201 civilian deaths-followed by 172 deaths from explosions. Reported deaths from airstrikes were most common in west Mosul, while reported deaths from explosions were similar on both sides of Mosul. Gunshots accounted for 86 cases, predominantly in west Mosul where ISIS snipers were particularly active. There were 35 persons who were reported to have been kidnapped, almost entirely prior to the military offensive. By the time of the survey, 20 had been released, 8 were dead, and 7 still missing, according to household reports. Almost all of the 223 injuries reported were due to intentional violence. Limitations to population-based surveys include a probable large survivor bias, the reliance on preconflict population distribution figures for sampling, and potential recall bias among respondents. CONCLUSIONS: Death and injuries during the military offensive to liberate Mosul considerably exceeded those during ISIS occupation. Airstrikes were the major reported cause of deaths, with the majority occurring in west Mosul. The extensive use of airstrikes and heavy artillery risks an extensive loss of life in densely populated urban areas. The high probability of survivor bias in this survey suggests that the actual number of injuries, kidnappings, and deaths in the neighborhoods sampled is likely to be higher than we report here.

Sex Differences in Civilian Injury in Baghdad From 2003 to 2014: Results of a Randomized Household Cluster Survey.

OBJECTIVE: To examine sex differences in injury mechanisms, injury-related death, injury-related disability, and associated financial consequences in Baghdad since the 2003 invasion of Iraq to inform prevention initiatives, health policy, and relief planning. BACKGROUND: Reliable estimates of injury burden among civilians during conflict are lacking, particularly among vulnerable subpopulations, such as women. METHODS: A 2-stage, cluster randomized, community-based household survey was conducted in May 2014 to determine the civilian burden of injury in Baghdad since 2003. Households were surveyed regarding injury mechanisms, healthcare required, disability, deaths, connection to conflict, and resultant financial hardship. RESULTS: We surveyed 900 households (5148 individuals), reporting 553 injuries, 162 (29%) of which were injuries among women. The mean age of injury was higher among women compared with men (34 ±â€Š21.3 vs 27 ±â€Š16.5 years; P < 0.001). More women than men were injured while in the home [104 (64%) vs 82 (21%); P < 0.001]. Fewer women than men died from injuries [11 (6.8%) vs 77 (20%); P < 0.001]; however, women were more likely than men to live with reduced function [101 (63%) vs 192 (49%); P = 0.005]. Of intentional injuries, women had higher rates of injury by shell fragments (41% vs 26%); more men were injured by gunshots [76 (41%) vs 6 (17.6%); P = .011). CONCLUSIONS: Women experienced fewer injuries than men in postinvasion Baghdad, but were more likely to suffer disability after injury. Efforts to improve conditions for injured women should focus on mitigating financial and provisional hardships, providing counseling services, and ensuring access to rehabilitation services.

Perceptions, experiences and expectations of Iraqi medical students.

BACKGROUND: The environment for medical education in Iraq has been difficult for many years. The 2003 invasion of Iraq accelerated a steady emigration of faculty and graduates. Kidnappings and deaths of doctors became commonplace. To understand current career plans, expectations and perceptions of medical students, three Baghdad medical schools were surveyed. METHODS: Written questionnaires were completed by 418 medical students variously in their 4th, 5th and 6th (final)years of training. We asked about perceptions of the quality of their medical education, the quality of health services in Iraq generally, and about deaths, injuries and migration of faculty, classmates and family. RESULTS: The average age of students was 22 years, with 59% women. Most students (90%) were originally from Baghdad. Although there were some positive responses, many students (59%) rated the overall quality of their medical education as fair or poor. Three-fourths of students believed the quality of hospital care in Iraq to be only fair or poor. A majority of students (57%) stated they were thinking frequently or all the time about leaving Iraq after graduation. Reasons given for leaving included the desire for further education, seeking a better lifestyle and fleeing conflict. Leading reasons for staying included the pull of friends and family, familiarity with the health system, and a sense of responsibility to the country. Nearly one in five (18%) students reported the death of a family member attributable to intentional violence, and 15% reported the violent death of a medical school classmate or faculty member since the 2003 invasion. Half the students reported at least one school faculty members had left Iraq because of the war. CONCLUSION: Medical students hold a mediocre view of the quality of their medical education and of Iraq's health system. Many of their faculty members have left the country. The majority of students may leave Iraq after graduation, afforded the opportunity. This poses a significant problem for staffing an already demoralized and stressed health system. Current circumstances suggest the situation will continue to deteriorate.

Prevalence of self-medication among university students in Baghdad: a cross-sectional study from Iraq.

The objective of this study is to find out the prevalence and determinants of self-medication among college students in Baghdad, Iraq. A cross-sectional survey was conducted in Al-Mustansiriyah and Al-Nahrain universities, Baghdad, from January to April 2015. A multistage random sampling technique was adopted to collect data from 1435 college students using a questionnaire form. The mean age of the joining students was 19.8 years. Females form 53% of the sample. Self-medications use was prevalent among 92.4% of students. Antipyretics and antibiotics were the most used medicines. Self-medication was higher among urban residents (OR= 7.99, P < 0.001). Students living with their families practiced self-medication more than others (OR= 2.501, P = 0.037). Students at health-related colleges showed greater resilience to self-medication (OR=0.455, P = 0.001). Despite free access to healthcare institutions, nine out of ten college students from Baghdad universities have practiced self-medication. Education of students about the safe use of medications and supervision of pharmacies are effective ways to control this malpractice.

Road traffic injuries in Baghdad from 2003 to 2014: results of a randomised household cluster survey.

INTRODUCTION: Around 50 million people are killed or left disabled on the world's roads each year; most are in middle-income cities. In addition to this background risk, Baghdad has been plagued by decades of insecurity that undermine injury prevention strategies. This study aimed to determine death and disability and household consequences of road traffic injuries (RTIs) in postinvasion Baghdad. METHODS: A two-stage, cluster-randomised, community-based household survey was performed in May 2014 to determine the civilian burden of injury from 2003 to 2014 in Baghdad. In addition to questions about household member death, households were interviewed regarding crash specifics, healthcare required, disability, relatedness to conflict and resultant financial hardship. RESULTS: Nine hundred households, totalling 5148 individuals, were interviewed. There were 86 RTIs (16% of all reported injuries) that resulted in 8 deaths (9% of RTIs). Serious RTIs increased in the decade postinvasion and were estimated to be 26 341 in 2013 (350 per 100 000 persons). 53% of RTIs involved pedestrians, motorcyclists or bicyclists. 51% of families directly affected by a RTI reported a significant decline in household income or suffered food insecurity. CONCLUSIONS: RTIs were extremely common and have increased in Baghdad. Young adults, pedestrians, motorcyclists and bicyclists were the most frequently injured or killed by RTCs. There is a large burden of road injury, and the families of road injury victims suffered considerably from lost wages, often resulting in household food insecurity. Ongoing conflict may worsen RTI risk and undermine efforts to reduce road traffic death and disability.

Effects of witnessing or exposure to community violence on mental health of Iraqi men.

BACKGROUND: Iraq is consistently exposed to large-scale traumatic events such as successive wars since 1980 to the present day, economic sanctions, sustained organized violence, and terrorism. These unsafe circumstances have negatively impacted the psychosocial status of the Iraqi community. OBJECTIVE: To study the prevalence of witnessing or exposure to various types of violence, and its association with mental health problems in a sample of Iraqi men. METHODS: This is a cross-sectional study that was conducted from April to September 2014. The target population were men from different age groups that were collected through a convenience sampling technique from two large cities; Baghdad (the capital city) and Mosul (the second largest city in Iraq). The source of data was from different institutions, colleges and lay people. The data collection process was done using the Self-Reporting Questionnaire 20 which is recommended by the World Health Organization for screening psychiatric disturbances. RESULTS: A total of 480 Iraqi males agreed to participate in the study. The main type of violence reported was witnessing violence (55.4%), followed by exposure of friends or relatives to violence (51.4%), and witnessing or exposure to sexual assault was least reported (3.8%). The most frequent feeling recorded was of worry (72.9%), getting easily upset (65.4%), suffering from headaches (62.7%) and lethargy (59.4%). Severe psychological changes were evident in 68.5% of men, while moderate changes were present in 31.5%. Analysis of the feelings and behavioral changes in relation to the participants' history of exposure to violence revealed a significant association with witnessing shooting or stabbings, displacement, friends or relatives' exposure to violence, and viewing corpses. CONCLUSION: There is a high prevalence among Iraqi men of exposure to, or witnessing violence that showed an association with their mental condition, which, if proved causally, may be a leading cause for future devastating effects on their health, wellbeing and quality of life.

Health services in Iraq.

After decades of war, sanctions, and occupation, Iraq's health services are struggling to regain lost momentum. Many skilled health workers have moved to other countries, and young graduates continue to leave. In spite of much rebuilding, health infrastructure is not fully restored. National development plans call for a realignment of the health system with primary health care as the basis. Yet the health-care system continues to be centralised and focused on hospitals. These development plans also call for the introduction of private health care as a major force in the health sector, but much needs to be done before policies to support this change are in place. New initiatives include an active programme to match access to health services with the location and needs of the population.

Relation between childhood experiences and adults' self-esteem: A sample from Baghdad.

BACKGROUND: Adverse childhood experiences are associated with significant functional impairments and loss of life in adolescence and adulthood. Literature documents the conversion of traumatic emotional experiences in childhood into psychological disorders later in life. The family is one of the most critical risks and resilient factors for mental health in adolescence and emerging adulthood. OBJECTIVE: To estimate the effect of childhood experiences on self-esteem during adulthood in a sample from Baghdad city. METHODS: This cross-sectional study was conducted in Baghdad city during the period from January 2013 through to January 2014. Multistage sampling techniques were used to choose 13 primary healthcare centers and eight colleges from three universities in Baghdad. Childhood experiences were measured by applying a modified standardized Adverse Childhood Experiences International Questionnaire (ACE-IQ) form. RESULTS: A total of 1040 subjects were surveyed and 1000 responded giving a response rate of 96.2%. The results revealed that 82.7% of the participants were confident within themselves, 14.9% (149) reported to feel a failure, while 28.3% of subjects expressed feeling useless at times. The score for family bonding is expected to significantly increase the score for self-esteem by a mean of 21.48. University, diploma and higher education are expected to significantly decrease the self-esteem score by a mean of - 6.31 compared to those with less than secondary school education. Parents education show statistically insignificant association with the mean score for self-esteem. CONCLUSION: The findings of this study give an insight into the essential role of childhood experiences in building self-esteem and adaptation later in their life. National health programs are suggested for intervention targeting early adverse childhood experiences and their consequences.