Year : 2022 | Volume
: 20 | Issue : 1 | Page : 65--67
Azhee: Turning personal grief into collective action against suicide
MA, Co-founder, Deputy Director of Azhee, Action Against Suicide, Erbil, Iraq
Royal City Apts., 44001, Erbil
Suicide is still a taboo issue in Iraqi society. Many in Iraq still feel shame in admitting that they have lost a loved one to suicide for fear of societal stigmatisation. With a lack of understanding about mental illness, it can be even more difficult for professionals to treat mental health issues properly. The cultural norms that stigmatise suicide create obstacles that discourage, or even prevent, many vulnerable people from reaching out for help. While life is full of challenges, suicide prevention is riddled with even more. Suicide prevention requires collective multisectoral intervention, but in the absence of endorsed national strategy, the interventions have been so far short-term and sporadic. Nongovernmental organisations like Azhee are not funded adequately to implement long-term, multisectoral interventions for effective suicide prevention. Different official entities collect and disseminate statistics on suicide, contradicting one another more than often. Absence of credible statistics at regional and national levels adversely affects the quality of interventions. The media in Iraq and its Kurdistan Region report irresponsibly on suicide which serves as a risk factor in relation to suicide. Another challenge is the weakness of coordination among national and international actors working in suicide prevention interventions.
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Abdulrahman S. Azhee: Turning personal grief into collective action against suicide.Intervention 2022;20:65-67
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Abdulrahman S. Azhee: Turning personal grief into collective action against suicide. Intervention [serial online] 2022 [cited 2023 Jan 27 ];20:65-67
Available from: https://www.interventionjournal.org/text.asp?2022/20/1/65/346334
Suicide is still a taboo issue in Iraqi society. Many in Iraq still feel shame in admitting that they have lost a loved one to suicide, or that they have experienced difficulties in their own mental health, for fear of societal stigmatisation. With a lack of understanding about mental illness, it can be even more difficult for professionals to treat mental health issues properly; the cultural norms that stigmatise suicide create obstacles that discourage, or even prevent, many vulnerable people from reaching out for help.
Suicide is the third leading cause of death among those aged 15-24, and the second leading cause of death among college students. About 90% of these people had a diagnosable and treatable mental health condition at the time of their death. We need to remember that behind every statistical data point with regards to suicide, there is a real human being and loved ones experiencing the grief of their loss. However, many in our society remain unaware that suicide is a national health and social problem.
At 16 years and eight months old, my son Taba, a young and talented boy, took his own life.
To us and those around him, he always looked so full of life and hope, smiling all the time and joking nonstop. So why, then, did he feel his suffering so profound and could not endure life anymore? To date, I am left filled with sorrow and many unanswered questions.
It is said that time heals all wounds but I believe it is the actions we take in that time that can help us to heal from loss. Two days after Taba's death, and while the condolence ceremonies were at peak, I announced that we would celebrate the birthday of his elder brother the day after. As a family, we took a collective decision that we would face death by celebrating life and give it a joyful meaning. A few months later, still filled with grief over the death of Taba, we celebrated his 17th birthday by launching a greening campaign in the city' s orphanages. Then we started a book collection campaign and established libraries in a number of villages and small towns in honour of our late son who had created a book club with his teachers and fellow students.
Turning Grief to Systematic Action
In our grief, we decided to do our best to support others who were we suffering like us due to loss of a loved one to suicide. All of a sudden, we found ourselves becoming like radar or a magnet picking up whatever news or hear-say about someone or another dying by suicide in the communities around us, so we started visiting them offering heartfelt condolences and sharing with them our experience with our own grieving process to let them know they were not alone and to help them avoid useless and harmful feeling of guilt they expectedly had.
As a family, Taba' s death transformed us completely. We realized that sharing our own experience could help those who have experienced a similar loss not to feel alone. Further, we thought that we could even help save the lives of others at risk. We chose to make meaning of our grief and became suicide prevention advocates.
Realising that there was a dire need for a large-scale and more systematic approach to tackle the issue at hand, and with help and support of some friends, we founded Azhee, a nonprofit and nongovernmental organisation (NGO) that started operating in the Kurdish Region of Iraq officially as of April 2019. With a plan to eventually expand to cover the entire country of Iraq, our main focus was on reducing the loss of life by suicide and offering support to survivors of suicide loss.
To address these underlying issues, we have been advocating for the understanding and prevention of suicide, and offering support to those who have been affected by it through initiatives such as fostering the connection of a network of families, all of whom have experienced a suicide loss.
Creating Momentum for Suicide Prevention Interventions
On 10 September 2019 and marking World Suicide Prevention Day (WSPD), we organised a national conference to mark the first International Survivors of Suicide Loss Day event in Iraq, where dozens of survivors of suicide loss from all over the country in our local community could come together with professionals, academics, government officials as well as representatives of national and international NGOs and accredited diplomats to raise awareness and bring understanding to those affected by this leading cause of death. After keynote speeches, the conference participants were divided into three working groups who produced a set of recommendations that were shared with the government and other actors for translation into concrete programmes. One of the recommendations was to push for the endorsement of the Iraqi government' s draft suicide prevention national strategy (SPNS).
In hosting the conference, we also aimed at destigmatising the issue of suicide in our community, pushing against cultural norms, and breaking the silence around this topic. The event was a great opportunity for those who participated to learn more about suicide and hear from those who had been directly affected by it.
The extensive media coverage that the conference received and the interviews that Azhee leadership and some guests gave on the day of the conference brought the issue of suicide to light at both media and academic levels. Two renowned universities in the country organised seminars on suicide prevention within the first week after Azhee' s conference.
The Coronavirus disease 2019 (COVID-19) pandemic and the total lockdown that the government imposed throughout the country early in 2020 made it more difficult for the members of our network of survivors to cope with their grief. To overcome this, we increased our online get-togethers and one-on-one sessions.
Further down the road and while the world was shifting to an online modality of work, we were approached by the Technical Work Group on Mental Health and Psycho- Social Support (MHPSS) led by the World Health Organization (WHO) to step up and do something about the increasing rates of suicide in Mosul and the neighbouring towns, as Azhee is the only organisation in the country completely dedicated to suicide prevention.
Looking into the cases reported, the effect of copycat and adverse impact of mass and social media through irresponsible reporting on cases of suicide were evident. Hence, utilizing WHO resources for responsible reporting on suicide as well as local and international sample journalistic reports, I took advantage of my 20 years plus of media experience and organised an online training course for media practitioners and civil society activists from the province in June 2020. The following month, I repeated the same training for journalists and NGO activists from Iraq' s central and southern provinces. In November 2020, and upon request from Heartland Alliance International, I facilitated a 4-day training for their community mobilizers. The trainees received in-depth knowledge about suicidal behaviour, misconceptions about suicide, risk and protective factors, assessment and management of cases, referral to specialised caregivers and how to involve the community in IDPs and returnee settings in Ninawa province.
Suicide Prevention National Strategy
Since review and eventually governmental endorsement of the SPNS was one of recommendations of Azhee's 2019 WSPD national conference, in September 2020, we organised an online workshop to launch the review of the draft. In addition to the MHPSS Senior Advisor of the federal Ministry of Health (MOH), who presented an overview of the draft strategy, the attendees also included senior representatives of the KRG/MOH, WHO, the International Organization for Migration (IOM), and a range of national and international NGOs operating in the country. After a keynote speech by the Azhee Founder and Director explaining the objective of the workshop, WHO gave a presentation on the key elements of a standard national strategy for suicide prevention, focusing on the LIVE Life approach. IOM's presentation centred around how we, as national and international actors involved in MHPSS and suicide prevention could contribute to the review process. Upon a suggestion by IOM and with the unanimous agreement by all present, the leadership of the review process was entrusted to Azhee.
Building on the momentum that Azhee's September 2020 workshop created and the outcome of Azhee meetings with both regional and federal ministries of health, IOM and the Secretariat of Iraq's Council of Ministers coorganised a 2-day “Suicide Prevention Conference” in Baghdad in November 2020, hosting Azhee as representative of civil society and all relevant government ministries to review the Draft Suicide Prevention Strategy.
Challenges of Suicide Prevention
As life is full of challenges, suicide prevention is riddled with even more. Suicide prevention requires collective multisectoral intervention, but in the absence of endorsed national strategy, the interventions have been, so far, short- term and sporadic.
Scarcity of funding for local NGOs like Azhee to implement long-term multisectoral interventions is another key challenge to effective suicide prevention.
In Iraq, four official entities collect and disseminate statistics on death by suicide and their figures contradict each other more than often. Absence of credible statistics at regional and national levels adversely affects the quality of the interventions.
The COVID-19 pandemic proved to be a real pain in the neck, not only because of its psychological toll on the mental health of suicide survivors but also because of having to shift all suicide prevention interventions to online modality.
Online training/workshops, which are low-cost by nature, are not as effective as in-person ones which require ample funds not available to local NGOs like Azhee. Azhee is now fully dependent on volunteers and is funded by my family savings that will not last long!
For us as suicide prevention advocates and programme implementors, the media in Iraq and its Kurdistan region is quite a challenge, as they report irresponsibly on suicide thus serve as a risk factor in relation to suicide.
Further, editors-in-chief and senior managers of key media outlets are so “full of themselves” that they refrain from joining training/workshops. Many journalists are reluctant to attend unless “tempting” incentives such as accommodation in a fancy hotel and a hefty “transport allowance” are offered. This limits our ability to train more journalists.
Another challenge is the weakness of coordination among the national and international actors working in suicide prevention interventions.
Stigmatisation remains the ultimate challenge making it difficult for vulnerable individuals to seek MHPSS support.
Healing Together and Saving Lives
As we continue to expand our outreach throughout Iraq, we know that it is just the start of what we can achieve together. We still have much work to be carried out to bring the topic of suicide out from the taboo, but we will continue to work each day to make our society smarter about mental health.
I advocate for Taba and countless others because advocacy can help save lives. I have shared my story countless times on various platforms including on TV and in trainings and workshops I facilitated. I always explain that in sharing the story, my purpose and intention have never been to beg for the audience's sympathy but rather to give a first-hand account of how a father who lost a son to suicide feels and how educating ourselves about mental health and detection of suicidal behaviour can save many lives that are at risk around us.
Whether you have experienced a suicide loss, have lived experience of suicide, or are an advocate for suicide prevention with no personal experience, I would encourage you to speak out, break the silence and create space for your community to share their own experiences. Let us offer support to each other, heal together and save lives.
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Conflicts of interest
There are no conflicts of interest.