Dr Satoo’s story: Improving access to care with dedication and hope in north-western Syrian Arab Republic

“Today, I’m one of the only psychiatrists in an area where about 3 million people live. Due to the war, the situation is tragic,” explains Dr Satoo, Psychiatrist and Managing Director of the WHO-supported Sarmada Mental Health Facility in north-western Syrian Arab Republic. “It affects everything: difficulties finding jobs and bad living conditions. No one is free from some sort of psychological problem. There are no official figures, but we are seeing more and more extreme cases each month.”

The ongoing escalation of the conflict in the region continues to impact heavily on civilians. Between 1 May and 18 August, over 570 000 people were displaced. Access to health care has also been severely limited. There are only 2 psychiatrists for almost 4 million people, and only 2 facilities have the capacity to treat people suffering from severe mental health conditions through inpatient care.

“There is no health facility but ours for severe mental and psychological illnesses. If this did not exist, where would families go? Some people are truly a danger to themselves, their family and their surroundings. Coming here is usually their last resort for dire situations,” Dr Satoo adds.

Improving access to care

Treatment options for people with mental health conditions are limited in north-western Syrian Arab Republic. Sarmada Mental Health Facility is one of 2 facilities with capacity to treat chronic mental health conditions that require hospitalization.

WHO supports the Facility with 20 inpatient beds and an outpatient clinic that provides an average of 321 consultations per month. The Facility treats various mental health conditions including schizophrenia, bipolar conditions and psychosis.

“Generally, we provide care to hospitalized patients for about a month. During that time, we hope patients are responsive to therapy and prescribed medicines. Afterwards, patients transition to our clinic for follow-up. We stress the importance of family members’ support in the treatment process,” Dr Satoo explains.

“Some time ago,” he continues, “we started treating a young man in his 20s. He was aggressive and had attacked his parents on several occasions. They came to me one night, after he had almost killed his mother with a knife. Due to a chronic psychosis, he believed she was conspiring against him and he suffered from many hallucinations. He believed that his family tried to hurt and poison him, and that his mother was the reason his wife had left him. It was difficult at first, but his family supported his road to recovery.”

Overcoming stigma

Receiving family support is vital for a patient’s recovery, but also one of the biggest challenges. “There is an element of stigma because no one would dare to admit that their family member suffers from mental health conditions,” Dr Satoo says.

“Families can get very angry at the patient and the community can expel them. As a result, people postpone or don’t seek care. Despite our efforts to break this stigma, a lot of patients go to religious healers rather than a psychiatrist. They tell them they are possessed or under the influence of bad spirits. We want to expand our services to help these people,” he adds.

Sarmada Mental Health Facility is operating at maximum capacity. One of the main barriers limiting expansion is a lack of specialist expertise. To fill this gap, WHO, supported by European Civil Protection and Humanitarian Aid Operations (ECHO), is implementing the Mental Health Gap Action Programme (mhGAP), which is designed to address common mental, neurological and substance abuse conditions.

By training general practitioners to treat mild to moderate mental health conditions, the burden on specialized staff is decreased. Despite his already heavy workload, Dr Satoo is the proud supervisor of 43 mhGAP trainees.

He expresses hope: “Many of my colleagues have backed out of the specialty or were affected due to circumstances of the conflict. You need a specific character to enter this field, it is not easy. I hope that the trainees will stay here because people need someone to serve them. These are their people and they are children of this country. We cannot leave these people without specialist support.”