Exiled Libyan psychiatrist returns to heal the hidden wounds of war

Widespread grieving and anxiety lift stigma on mental health care in Libya

By Saleyha Ahsan and Michael May

Dr. Omar Reda (courtesy of Omar Reda)

On a windy night in December 2011 in Tripoli, a group of battle-hardened men sat in a lounge in Col. Muammar Gadaffi’s former seaside holiday compound, at that moment the headquarters for the Jaadu Khatiba, a rebel army unit. The salty wet air pushed against the windows as Dr. Omar Reda, a psychiatrist and professor from the Oregon Health and Science University, spoke calmly in Arabic.  In a supportive tone he asked the soldiers if any of them were having trouble sleeping or eating. Some responded saying yes. Reda told them that this was a normal reaction to what they had been through and that they didn’t have to face it alone.

The men were here as part of a wider program being offered by Reda to help fighters overcome post-traumatic stress disorder. As he continued to talk, the men became more reflective. Eyes would focus on Dr Reda and then lower to the floor as they contemplated his words.

Some engaged in conversation, talking about how they’d adapted to the stress of war. One soldier mentioned the use of strong narcotics such as Tramadol, which was being illicitly sold by tea sellers that line the seafront. Others admitted to insomnia. But none of the men admitted to needing formal help, even in confidence. Reda can help Libyans cope with their anxiety and insomnia, but he has to overcome a deep stigma over accepting mental health care.

Reda was back in his home country because there aren’t enough local Libyan therapists to fill the need. As we walked into Tripoli’s only psychiatric hospital, Dr. Reda was surprised to see hospital beds in its reception area. “I have not seen a bed in a consultation room for years,” he said. “We don’t put patients onto beds.”

Despite the challenges, Dr. Reda has come back to his home country to help heal the wounds below the surface. Dr. Reda grew up in the city of Benghazi, and got his medical degree in Libya in 1998. He had wanted to specialize in psychiatry, but there weren’t any jobs. He ended up working in an emergency room at first and later studied psychiatry in the United States. Latitude News caught up with Dr. Reda at his office in Portland, Oregon.

Why did you leave Libya?

It started when a group of my friends became politically active and wanted, through non-violent means, to change the regime. They were put in prison and some of them were executed. I ended up going to their families, checking on children and providing moral and financial support. My name was put on Gaddafi’s list.

I didn’t know about it. One day I came back from the emergency room. I came home and found my dad waiting for me at the front door with a bunch of cash. Through connections, he knew I was going to be arrested. He said, ‘You have to leave immediately.” I had five minutes to say a quick goodbye to my mom and dad. I didn’t see my siblings or anyone.

How would you compare psychiatric care in Libya and the United States?

In my home city of Benghazi, which has 750,000 people, there was only one psychiatrist in 1998. And that one psychiatrist was not very busy, because of the stigma of mental health care. In that part of the world, people still believe if you have emotional issues, it is a sign of weakness—that you are not close to God or maybe it’s because of your sins, or a result of magic or evil health. They usually blame the victim.

Here in the U.S., the stigma is much less. People are open to talking about their feelings and it’s normal practice to have someone they talk to on a regular basis.

One thing that is positive that came from the Libyan situation is the stigma is going away. People are grieving together. Many people who lost loved ones are open to talking about it. So people are seeking services. Psychiatrists there are very busy for the first time in their lives.

When did you return to Libya?

I went back in the first week of conflict in February 2011. My city, Benghazi, was under threat of being bombed. My family was under fire. I called home. I could hardly get a connection. One day, I finally got hold of my mom. She told me, ‘Tonight Gaddafi has threatened to bomb the city. I love you, son. I’m proud of you. I’ll see you in paradise.’ That was too much for me. I immediately flew to Libya through Egypt.

I hadn’t been in the country for 12 years. And for the first time I heard people using these big words like freedom and democracy and human rights. They were excited but scared at the same time. It was a fantastic feeling to see my family. I was also blessed to have help from a non-profit in Portland called Medical Teams International. They sent me with $400,000 worth of medication and I took it to the front lines.

I went to Libya three times and am planning a fourth trip for June. The first time, they didn’t want to hear the word ‘psychiatry.’ They said, ‘We don’t need mental health treatment, these are normal reactions to war.’ I agreed with this. The country was still under the gun. The surgical and medical needs took precedence. So I didn’t push the issue.

When did you return to provide psychiatric help?

The children’s tent in Misrata, Libya (Omar Reda)

I went back in June for three months to the city of Misrata. I was doing psychosocial work with children for a group called Mercy Corps. Misrata was the city that suffered the most destruction. There were many people who died and women who were raped and so on.  It was the city that needed the most help.

It was the most rewarding experience in my life. I specialize in post-traumatic stress disorder, or PTSD, and had done training for trauma victims and refugees. I never imagined I would be applying those skills in my own country and with my own people. But I felt blessed to have that training, it was helping with my own emotional needs as well.

For the work with the children of Misrata, we set up tents in the middle of the city and then we had volunteers that came and did play and art therapy with children. Many children are not able to express feelings through words, but can do it through singing, painting and so on.

How did you help the children cope with the war?

We have many techniques we use, like talking about feelings in non-threatening ways, exploring support systems and habits. We worked a lot on changing misconceptions. Many children feel guilty when a loved one dies. They blame themselves. And many children are not aware of the permanence of death and think a loved one will come back.

So we helped them cope with their guilt issues and gave them a safe environment to release energy. We also provided a lot of advice to parents and caregivers about nightmares and other symptoms. If adults are anxious and we can take care of that, then the children’s anxiety goes down significantly.

Dr. Reda playing with children in the program run by Mercy Corp.

We also used stories, songs, physical exercise, games and art with the children. And we saw amazing improvement. In the first weeks, the children were drawing pictures of tanks, dead bodies, blood and explosions.  After providing activities and advice, they started talking about how they missed school and they talked about how they wanted Libya to be a free country. And they started drawing pictures full of colors, flowers and other future-oriented things.

And we were very open to any adults who wanted to talk. But we didn’t force anyone to talk who wasn’t ready. And many are not ready, so that’s why it’s important to build a safe haven for them, and keep inviting them again and again. They can come and have snacks and tea, if they want to talk, fine, or they can just bring their children to do art in the tent.

What did you work on with the adults?

We did open dialogues between children’s parents, even between pro and anti-Gaddafi factions. We didn’t discriminate. And we can’t take care of everything, some of the feelings will continue. Some lost children fighting for Gaddafi, and they don’t want to say that their child died for the wrong cause. And we emphasized that we don’t want to blame a family for what a child did, or blame a child for what the father did.

You have worked with soldiers with PTSD here in the United States. What was different in Libya?

In Libya, they tend to express PTSD through physical symptoms—headaches, stomach aches, shaking and so on. It’s up to the professional to explore, using questions, and find the source of anxiety.

And there, Libyans were fighting each other. Here in U.S., the soldiers were not fighting against each other. Libyan soldiers have a lot of guilt, even if they fought against Gaddafi and felt like they were on the right side. They still feel a lot of guilt over killing another Libyan.

And for people who fought for Gaddafi, they are also dealing with a lot of guilt, perhaps feeling like they fought for the wrong reason. Guilt is something both sides are dealing with, much more than U.S. soldiers coming back from Afghanistan.

The positive thing is that Libyans are reaching out to their support system and to professionals. People are grieving together. People are open to talking. Both directly and indirectly, they are talking about their own struggles. And that’s something that will bring lots of healing. We are very blessed that war didn’t go on and on like in Syria. It came with heavy price, but at least Libya can start healing now. And I hope to be part of it.

Dr. Reda will be returning to Libya in June to work on his own project, Libya Al-Shefa (Healing Libya), that will focus on public awareness of mental health issues and the need for reconciliation.