Sally Hayden
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Inside a traumatised Aleppo: “Many children may suffer in the future”

“Syrian families are supposed to live next to each other. Now they are all gone.”
 

Every morning, afternoon and night, Bassam Hayek obsessively checks WhatsApp. He’s flicking through it as we speak, and when he speaks, images of horror, of conflict brutality and domestic abuse he’s receiving through the messaging service run across his mind, forcing him to pause while he filters what he should say aloud.

It’s been one year since the fall of east Aleppo. Slowly, some families displaced by the conflict have begun to move back to their homes. Many former opposition areas remain almost deserted, left without electricity or water, but a few shops have reopened, powering their lights with generators. Hundreds of thousands of the city’s residents are dead or displaced.

But for the estimated more than 1.5 million who are left behind there is another looming issue.

Hayek, the director of Aleppo’s psychiatric hospital Ibn Khaldoun, said the city is facing a mental health crisis - particularly among its children. In the whole of Syria, he told me, there isn’t one paediatric psychiatrist, though this sort of specialism is desperately needed.

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I was in government-held Syria on a rare journalist visa. Most of the time I had a minder, assigned by their Ministry of Information, who was present during most interviews. I wasn't stopped from speaking to anyone and met the majority of interviewees by chance, though many refused to talk explicitly about politics, including Hayek, who said his mission is a medical one. We've stayed in touch through Facebook since.

When I visited the hospital’s outpatient centre in central Aleppo, the corridors were lined with patients waiting to be seen. On average, some 250 patients turn up each day, Hayek said. Before the war, they saw as few as 15. The vast majority are suffering from anxiety or depression-related illnesses, including regular panic attacks and sleep disorders. 

“Especially, we have the problem of the children,” Hayek said. “Small children, when they see weapons and blood and victims in front of them, they’ll be aggressive in school, at home, they’ll have attention problems.”

Syria’s revolution came to Aleppo relatively late: protests began in 2012. Within months, one of the oldest inhabited cities in the world had become a key battleground. Over the next four years, many families barely went outside for fear of snipers, harassment at checkpoints or other attacks. This was devastating for children, who - unable to run or play with friends - were particularly at risk of developing anxiety and trauma-related disorders.

Hayek said depression, anxiety and sleep disorders are all evident in young people his doctors treat: “For adults they can manage stress in many different ways, but children haven’t any way to manage it.”

Since the war began in 2011, more than half of Syria’s doctors have left a country now labelled "the most dangerous place on earth for healthcare providers." The medical crisis has been particularly damaging to psychiatry, Hayek said, given it wasn’t a popular specialisation to begin with. There are only 60 psychiatrists left in the whole of Syria, he noted, along with around 30 psychotherapists and 1,000 psychologists.

From Ibn Khaldoun, the only psychiatric hospital in the north, 50 percent of the staff left their jobs - either to go abroad or to move to opposition areas. Despite the borders and checkpoints between them, many stay in touch by Whatsapp, regularly messaging to compare treatments and talk about diagnoses.

Aleppo’s remaining psychiatrists have now begun visiting schools and mosques to offer support, as well as training teachers to diagnose children who need treatment.

One thing Hayek says helps is walking through emergency procedures with young people, and informing them what do to when their school is hit by a bomb or mortar, because this can help them feel more in control. However, a better cure is simple childhood activities: drawing, playing, singing or football.

Children’s resilience also depends on the social network they have remaining, he said. “Our society is built on the family itself.” So many people have left that it’s fractured people’s support systems, leaving many unable to cope. “Some go to Europe, some got killed.”

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Over the past few years, Hayek has treated people from across the countryside, including opposition-held Idlib and, until recently, Isis-held Raqqa. Each patient is given a document saying he’s a patient, and Hayek said militant groups, including Isis and Al Nusra, will let them pass checkpoints.

Hayek himself has been captured by Isis. They broke his nose, he laughs with some bravado, adding, “I know how to talk to them.” He said he told them he was a doctor, so they let him go.

In 2013, the building Ibn Khaldoun uses for in-patients was also captured by an Al-Qaeda-associated group, though Hayek says he rarely talks about what happened next. 

Militants went through those with mental illnesses, eyeing them up and insulting them, he says. One man, who was suffering from delusions, uttered the words: “I am Allah." It was considered blasphemous, and he was murdered on the spot.

Hayek himself was forced to move house three times to avoid fighting. He said his own children are longing to go home. “All of us have depression sometimes.”

The World Health Organisation supports the hospital, and sources them unbranded medication. It often comes from Bulgaria or Cyprus, necessary because pharmaceutical companies are worried about US sanctions on Syria. The drugs are often brought through Turkey and Lebanon to avoid detection, Hayek says. 

In the longer term, Hayek predicted, there will be a PTSD crisis. “Many children in five or ten years might start suffering in the future.” He estimates that 50 percent of people in Aleppo will need psychological help.

He said there aren’t high rates of suicide, though joked “some of us say we’re still here, so this is a suicide attempt itself.”

“The good thing about the crisis was that it slowed stigma,” Hayek said. “Now people understand (mental illness). Before there was a stigma about psychiatric disease, and psychiatric hospital, and psychiatric treatment, but now it is less.” Before the war, he claimed people used to avoid the area around the hospital because they were afraid of running into patients.

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Across Syria and in refugee camps outside, parents ask advice for their children’s persistent health problems. Often, they’re caused by anxiety. The children won’t sleep, refuse to leave home, or simply stop talking, withdrawing into themselves. In Zaatari camp in Jordan, a mother told me her son was developing kidney problems because he was afraid to go to the bathroom. In Lebanon's Bekaa Valley, a father said his child felt constant pains running all over her body. In a school for children with Down's Syndrome in Homs, one tutor told me her traumatised students were abnormally active, moving all the time like they were frightened to stop, and become aggressive when they're asked to.

In one former opposition area in Aleppo's east, a girl of about six wearing a leopard-print onesie spotted me taking photos. She approached me shyly to invite me to her family’s apartment on the fifth floor of a building close by. From their window, the landscape is flattened, all rubble. At night, theirs is the only light that shines in a neighbourhood that once housed hundreds of their relatives.

Upstairs, her father Huossen, 40, told me of the year they barely left home, when Syrian army attacks continued, while opposition fighters began fighting each other and it became hard to tell which group was in charge. He spoke of an epic 13-hour journey, when he and his wife finally bustled their six daughters and son through checkpoint after checkpoint, paying bribes and praying constantly on their way to escape. 

After they left, the final roads to the east were cut off, and the area was bombed regularly by Syrian forces, who have been accused of deliberately targeting hospitals and using a "surrender or starve" tactic to force the rebel groups to give up. The eventual evacuations that happened were classified as a war crime by the United Nations-mandated Independent International Commission of Inquiry on Syria.

Huossen's family have been back home again since August, but life is hard, and he can see it in his children. “My daughters have fragilities,” Huossen said. “Two of them have stomach problems.” He doesn't know how long this will last.

Looking out at the destruction that lies in front of him, Huossen then sighed. “It is difficult,” he said. “Syrian families are supposed to live next to each other. Now they are all gone.”

Sally Hayden is an award-winning journalist and photographer currently focused on migration, conflict and humanitarian crises. Save the Children is working in northern Syria to set up safe spaces for children. You can find out more about the charity's work here.

A 1907 painting of Spinoza, who was excommunicated from Judaism in 1656. Credit: SAMUEL HIRSZENBERG
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Why atheists are true believers too

How atheisms are imitating the religions they claim to reject.

In 1995 Richard Dawkins became the first ever “professor for the public understanding of science” at Oxford University. By the time he retired, 13 years later, it looked as if he had privately renegotiated his contract; for he was now functioning as Oxford’s very own professor for the public misunderstanding of religion.

In The God Delusion (2006) he argued that the existence of God was a scientific hypothesis which was almost – almost – demonstrably false. Miracles were scientifically impossible (yes, professor, I think we knew that: the clue was in the word “miracles”). And the creation story in the Book of Genesis was very bad science indeed. Opposing the stupidities of modern “creationism”, and all the other pseudo-scientific or anti-scientific dogmas of the fundamentalists, is one thing. Criticising the moral evils committed by religious fanatics is another, and no less worthwhile. Yet to treat religion itself as merely a defective form of science is a strangely crude error, rather like thinking that poetry is just a way of conveying factual statements that are to be tested for their truth or falsehood.

In his new book, Seven Types of Atheism, John Gray – who, I should mention, is no more a religious believer than I am – has little time for the so-called New Atheism of Dawkins and Co. The confusion of religion with science is only one of the points he objects to. Even if it can be shown that religion involves the creation of illusions, he argues, that does not mean that religion can or should be dispensed with; for “there is nothing in science that says illusion may not be useful, even indispensable, in life”. As for the idea of the American New Atheist Sam Harris that we can develop “a science of good and evil” which will contain all the correct liberal values: Gray sees this as a piece of astonishing and culpable naivety, ignoring nearly two centuries’ worth of evidence that scientism in ethics and illiberalism go happily hand-in-hand.

If this short book were just another intervention in the Dawkinsian “God debate”, it would be very short indeed. In fact it would get no further than page 23 where, at the end of his brief opening chapter, Gray concludes damningly that “the organised atheism of the present century is mostly a media phenomenon, and best appreciated as a type of entertainment”.

But the New Atheism is the least of the seven varieties that make up the subject-matter of this book. The others are all much more interesting, being connected with significant elements in our culture. And if the phrase “our culture” sounds parochial, well, that is an issue Gray deals with explicitly, pointing out that what we call “atheism” is something much more specific than just a rejection or absence of religion as such. It is a rejection of certain religious beliefs – and that narrows the field already, as many religions of the world are not primarily belief-systems at all. In particular, Gray argues, it is a rejection of belief in an omnipotent creator-god, which means that while atheism is Christianity’s close relative, it bears no relation to Hinduism or Buddhism at all.

So this is a book about post-Christian thinking – most of it, in Gray’s view, pretty bad thinking, too. One of his targets is secular humanism, which he describes as “a hollowed-out version of the Christian belief in salvation through history”. Another is what he calls “making a religion from science”, a delusion which he traces all the way from Mesmerism in the late 18th century, via dialectical materialism in the 19th and 20th, to those futurist thinkers today who dream of uploading a human being’s consciousness to computer circuits, thereby rendering it immortal. And another is political religion, “from Jacobinism through communism and Nazism to contemporary evangelical liberalism”.

Obviously there are overlaps between these three varieties of modern atheism; dialectical materialism, for instance, has also formed part of the creed of Marxist political religion. The one fundamental thing they have in common, on Gray’s account, is that they are all doctrines of progress, of an onwards and upwards march of humanity through history. Whether he is right to say that secular humanism is committed to this view, I am not so sure; doubtless, those who believe in humanist ethics will also think that if more and more people adopt their ethical system the world will become a better place, yet it’s not clear why they should regard that as inevitable.

But one thing at least is clear: John Gray regards all belief in human progress as the most pernicious of delusions. Despite all his eloquence on this subject, some readers may feel that his argument runs away with him, taking him further than he needs to go. It would be enough, surely, to say that the basic moral qualities of human beings have not changed over time, and that there’s no reason to think that any improvements in human behaviour that have taken place are part of a pattern of inevitable progress. Yet Gray goes further, claiming that there has been no real improvement at all.

The abolition of slavery? Slave auctions in “Islamic State” territory have been advertised on Facebook. The abandonment of torture? It has persisted at Guantanamo Bay. Well, yes; but having pockets of slavery here and there in the world is not the same as the situation 200 years ago, when it was a huge and entrenched institution, questioned only by a small minority. Yes, torture continues, but not as a standard judicial procedure. And in many countries there have been substantial, long-term changes in attitude and treatment where female subjugation, child labour and the criminalisation of homosexuality are concerned. Surely there must be some way of acknowledging this, without relapsing into Pollyannaish Steven Pinkerism?

One reason for Gray’s emphasis on the theme of temporal progress is that it fits these various secular atheisms into a larger pattern – that of salvation through history. And this brings us to the core of his argument: out of the whole range of major religions, only Christianity works in a historical dimension like this, which means that the secular atheisms are imitating, or unconsciously reproducing, a central feature of the very religion they claim to reject.

He makes this point again and again. These modern atheists’ view of the world is “inherited” from Christianity. Their belief in progress is “a secular avatar of a religious idea of redemption”. Jacobinism and Bolshevism were “channels” for the millenarian myths of Christianity. Bolshevism was in a “lineage” going back to medieval millenarianism. The apocalyptic myths of radical Christian movements “renewed themselves” in secular, political forms.

Having watched Gray wield his scalpel so effectively on other writers’ arguments, I can’t help thinking that this one deserves a few incisions. What does it mean to say that a communist who yearns for the coming of the classless society is really expressing just the same view as a millenarian looking to the reign of Christ on earth? The form of the belief may be roughly similar, but the content is entirely different. And if these are “inherited” ideas standing in a “lineage”, what is the evidence of a continuous chain of transmission – from, say, the 16th-century radical Anabaptists of Münster (whose chaotic quasi-communist experiment Gray describes in graphic detail) to the Bolsheviks of Petrograd and Moscow? As for the religious myths “renewing themselves” in a secular guise: this seems perilously close to the mindset of Dawkins’s theory of “memes”, which Gray has scornfully dismissed as hardly a theory at all.

Gray also mentions a Gnostic “impulse” that has recurred, unchanged, over two millennia. But if the same impulse can produce a religious idea in one period and a secular one in another, it seems that the impulse is something that stands behind both, itself neither secular nor religious. In which case, the modern atheisms may be not so much reproducing religious beliefs as expressing some basic yearnings that are pre-religious or non-religious in themselves. These are dark theoretical waters, and I am not convinced that Gray has got to the bottom of them.

Yet what he has done is to produce a marvellously stimulating account of some major currents of post-Christian thought, in which ideas and arguments leap constantly off the page like white-hot sparks from an anvil. The dismissals are concise and often devastating; but there are also wonderfully funny details, lovingly accumulated by a wry observer of human foolishness. It is nice to learn, for example, that Auguste Comte’s secular religion of Positivism imposed on its followers “special types of clothing, with buttons placed on the back so that they could not be worn without the help of others – thereby promoting altruism”. And I would challenge anyone to read Gray’s account of the cult of Ayn Rand, with its compulsory cigarette-smoking and rational tap-dancing, and not laugh out loud.

But what of Gray’s own post-religious beliefs? He certainly does not belong in the fifth category discussed here, that of “misotheists” – the Marquis de Sade, Dostoevsky and William Empson – whose views were shaped by a positive hatred of God. (Here, at least, he has no difficulty in showing that some kinds of atheism are dependent intimately and inseparably on Christian theology.) Gray’s own sympathies are divided between his two final varieties: the naturalistic, undogmatic and guaranteed progress-free atheism of the philosopher George Santayana; and the philosophico-theological theories of Spinoza and Schopenhauer, which argued obscurely both that a greater reality, possibly to be identified as Spirit or God, existed, and that to talk about it as a god who created the world, or intervened in it, or issued commands to humans, was to misunderstand it entirely.

Santayana was himself an admirer of Spinoza, and towards the end of the book, Gray quotes his characterisation of the Dutch-Jewish philosopher as follows: “By overcoming all human weaknesses, even when they seem kindly or noble, and by honouring power and truth, even if they should slay him, he entered the sanctuary of an unruffled superhuman wisdom.” I am not sure that this is quite the image that readers should take away of Gray, whose tolerance of human weaknesses – at the personal level, if not the intellectual one – seems admirably generous. Nor can it be guaranteed that people will acquire unruffled superhuman wisdom by reading this book. More likely they will find themselves tremendously, even painfully, ruffled. And I mean that as high praise, for an author who is one of the greatest intellectual provocateurs of our time. 

Noel Malcolm is editor of the Clarendon Edition of the Works of Thomas Hobbes and a fellow of All Souls, Oxford

John Gray will appear in conversation with Jason Cowley at Waterstones Trafalgar Square, London WC2, on 2 May (newstatesman.com/events)

Seven Types of Atheism
John Gray
Allen Lane, 176pp, £17.99