The document discusses the history and current state of psychiatry in the Arab world. It describes how Islamic hospitals (bimaristans) in the Middle Ages included sections for treating mentally ill patients. Notable early Muslim physicians and scholars like Rhazes and Avicenna made important contributions to the field. Today, most Arab countries have national mental health policies and legislation but resources and services remain limited. Rates of psychiatric disorders are high while numbers of psychiatrists, beds, and facilities are low in many areas. Efforts are being made to shift care from large institutions to community services.

1. The development of
psychiatry in the Arab
world : the challenges and
perspectives
WALID SARHAN
Consultant Psychiatrist
Amman-Jordan

2. Islamic Bimaristans in
the Middle Ages
• the first proper Bimaristan built in Islam was in
Damascus, by al-Waleed bin Abdel Malek
and built in 86 Hijri (707 A.D.)
• They divided the Bimaristan into two
sections, one for men and the other for
women.

3. Section for psychiatry
The halls of internal medicine which
frequently included a section for the
patients affected by fever and another
one for patients having mania.

4. • Muslims realized the importance of the care
for mentally affected patients. They
frequently added to the big Bimaristans
special places isolated by iron bars,
specially for patients with mental diseases
• Muslim physicians knew that psychiatric
and mental diseases required a special
type of care and that the physician must
be acquainted with the etiology of the
disease from which the patient is suffering.
Mental Disease Bimaristan

5. Medical education
 The theoretical method in the medical
schools.
 A practical method for training and practice
where students gathered around the doctor
in chief to see and examine the patients and
the treatment he prescribed.
 When the students finished the studying
period they applied for an exam, took an
oath and got their certificates.

6. Mohd Zakria Razi
• While in Arabia & parts of Asia there was a revival
of scientific interest in Greco- Roman Medicine.
• 705 AD: Asylum 4 mentally ill….in Baghdad
• 900 AD: Rhazes ( Mohd Zakria Razi )
• One of the Greatest name in Arabian Medicine
• known as Persian Galen
• Director & chief physician at Baghdad
hospital
• wrote more than 200 books
 The first psychiatrist in history

7. • A Persian physician and philosopher, born near
Bukhara.
• He is regarded as a father of early modern
medicine and clinical pharmacology, celebrated
until today by nations of the East and West.
• History records that in Arabia & Asia mentally ill
patients received a much more treatment than
the patients in the dark ages of Europe.
• Muslim belief: insane were loved by God
1000 AD: Avicenna (Ibn
Sina )

8. Al-Ghazali
• The great philosopher
• The first psychologists
• Al-Ghazali has sometimes been referred to
by historians as the single most influential
Muslim after the Islamic prophet
Muhammad(PBU)

9. Landmarks
• Service
• Rehabilitation
• Psychiatry
• Psychology
• Sociology
• Hospitals

10. Arab World

11. The Arab world
• The Arab world is taken to mean the 22
members of the Arab League, accounting
for 280 million people. The region has the
largest proportion of young people in the
world: 38% of Arabs are under 14. Life
expectancy has increased by 15 years over
the past three decades.

12. Arab World
• The Arabic language forms the unifying feature of
the Arab World.
• Though different areas use local varieties of Arabic,
all share in the use of the standardized classical
language, which was constructed from Classical
Arabic

13. Religion
• The majority of people in the Arab World adhere to
Islam and the religion has official status in most
countries.
• Overall, Arabs make up less than one quarter of the
world's 1.4 billion Muslims

14. Individual Development in
Arab Societies
 Arab societies tend to be "father
dominant" (patriarchal): The father is
the head of the family and is
considered a powerful and charismatic
figure. He commands respect as the
legitimate authority for all matters of
the family (El-Islam, 1983).
 The patriarchal structure extends
throughout all levels of society.

15. Individual Development in
Arab Societies-cont.
 The father of the nuclear family is subordinate
to his own father, who in turn defers to the
authority of the head of the clan. All clan
heads are subordinate to the head of the tribe
or hamula.
 The tribal or clan leader also serves as the
spiritual and practical father of the whole
group—he represents the collective to the
outside world, oversees the rules for the clan or
tribe, and guides their actions.

16. Is the Western nosology applicable also
to members of the Arab/Muslim
culture?
• Individuals are not individuated from the
collective, the mind and body are not
distinct entities, and the internal
constructs of personality (emotions,
thoughts, self, super-ego) are not distinct
one from the other?
M.Dwairy

17. Heterogeneous Arab population
• The rapid changing Arab society has
lead to heterogeneous groups in the
society.
• Some Arabs are still very traditional while
others have developed the western
attitude to various degrees, in the same
family and the same city or country.

18. The place of Arabs in
science
 Arabs comprise 5 percent of the world’s
population, but publish just 1.1 percent of its
books, according to the U.N.’s
 Between 1980 and 2000, Korea granted 16,328
patents, while nine Arab countries, including
Egypt, Saudi Arabia, and the U.A.E., granted a
combined total of only 370, many of them
registered by foreigners.
2003 Arab Human Development Report.

19. Education
• The region’s average mean years of
schooling of six years is 1.3 years higher
than those of South Asia and sub-
Saharan Africa regions but 1.5 years
below the World average and over four
years below the average for Europe and
Central Asia.

20. Violence
• Wars
• Terrorism
• Occupation
• Revolution
• Demonstration

21. Scientific and technical journal articles
2007
The world 758,137
20,980Spain4,980Greece413Algeria
36Sudan18,194India3,264Argentina
79Syria4,366Iran17,831Australia
757Tunisia6,623Israel41Bahrain
8,637Turkey52,896Japan235Bangladesh
214UAE344Jordan7,071Belgium
47,121UK242Kuwait27,799Canada
209,694USA238Lebanon56,806China
18Yemen30Libya5,236Denmark
44,408Germany377Morocco1,934Egypt
13,953Russia129Oman149Ethiopia
589Saudi Arabia48Qatar30,740France
3,792Singapore

22. EXPENDITURE ON
HEALTH
According to the WHO World Health Report (2001)
the health expenditure estimated as percentage
of gross domestic product is highest in Lebanon
(11.3%) followed by Jordan (8.8%), Tunisia (5.3%)
and Bahrain (5%). None of the remaining Arab
countries fulfilled the WHO recommendation of a
minimum expenditure of 5% of GDP on health. In
none of the sources could we find a reference to
the specific expenditure on mental health services.

23. Mental health expenditure
• The mental health expenditure as a
percentage of total health expenditure is
not available in most Arab countries and not
reported by the officials. Only three Arab
countries have provided an estimate: Qatar
(1%), Egypt (less than 1%) and Palestine
(2.5%).

24. Adult literacy rate (both sexes) (% aged
15 and above)
GDP per capita (2008 PPP US$)
2010 2010
Algeria 77.6
1
8,477
2
Bahrain 90.0
1
27,838
2
Egypt 66.4
3 4
5,840
2
Iraq 74.1
5 6
..
Ireland .. 38,768
2
Jordan 91.1
7 8
5,700
2
Kuwait 94.5
8 9
50,284
2
Lebanon 89.6
8 9
13,510
2
Libyan Arab Jamahiriya 88.3
1
16,999
2
Morocco 58.2
1
4,638
2
Occupied Palestinian Territories 93.8
8 9
..
Oman 86.3
1
26,258
2
Qatar 93.1
8 9
77,178
2
Saudi Arabia 86.7
1
24,208
2
Sudan 60.9
5 6
2,300
2
Syrian Arab Republic 84.7
1
4,857
2
United Arab Emirates 90.0
7 8
56,485
2
Yemen 63.2
1
2,595
2
DEVELOPMENT
REPORT2010

25.  In Egypt there are 3 journals published in English:
Egyptian Journal of Psychiatry, since 1978 Current
Psychiatry, since 1995 Journal of Neurology Psychiatry
and Neurosurgery,
 In Algeria the official journal of APA, in French.
 In Jordan there is the Arab Journal of Psychiatry, since
1989
 Eastern Mediterranean Health Journal, the official
journal of
 WHO/EMRO
Psychiatric journals in the Arab World

26. Prevalence of psychiatric
disorders
• The lifetime prevalence of any anxiety
disorder among adults was 16.7% in the
Lebanese study and 13.8% in the Iraqi survey;
that of any mood disorder was, respectively,
12.6% and 7.5%. The study carried out in
Morocco reported a point prevalence of 9.3%
for generalized anxiety disorder and 26.5% for
major depressive disorder, while the Egyptian
study reported a point prevalence of 4.8% for
anxiety disorders and 6.4% for mood disorders

27. Mental health legislation
• The Eastern Mediterranean Region (EMRO)
office of the WHO, national psychiatric soci-
eties and national psychiatric leaders. Six
out of 20 countries do not have a mental
health legislation and two do not have a
mental health policy. There is no information
for Mauritania and Comoros.

28. Addiction
• 6% of adult population.
• Hashish-amphetamines-Heroin.
• Inhalants in children and adolescents.
• Smoking cigarettes and Hubble bubble.
• Alcohol.??
• The Arab world is undergoing an epidemic of
substance misuse with very poor services.
• The treatment of substance misuse is part of
the poor mental health services.

29. Psychiatric hospital beds
• three countries (Lebanon, Kuwait and
Bahrain) had in 2007 more than 30
psychiatric beds per 100,000
population, while two (Sudan and
Somalia) had less than 5 per 100,000. A
substantial reduction of psychiatric
beds occurred in Iraq, Jordan, Kuwait,
Libya, Oman, Qatar and Palestine.

30. Country Mental health policy (year) Substance abuse
policy (year)
Algeria Yes (?) Yes (1990)
Bahrain Yes (1993) Yes (1983)
Djibouti No No
Egypt Yes (1978) Yes (1986)
Emirates Yes (?) Yes (?)
Iraq Yes (1981) Yes (1965)
Jordan Yes (1986) Yes (2000)
Kuwait Yes (1957) Yes (1983)
Lebanon No No
Libya Yes (?) No
Morocco Yes (1972) Yes (1972)
Oman Yes (1992) Yes (1999)
Palestine Yes (2004) Yes (2004)
Qatar Yes (1980) Yes (1986)
Saudi Arabia Yes (1989) Yes (2000)
Somalia Yes (?) Yes (?)
Sudan Yes (1998) Yes (1995)
Syria Yes (2001) Yes (1993)
Tunisia Yes (1986) Yes (1969)
Yemen Yes (1986) No
Mental health policies in Arab countries

31. Country National mental health Mental health legislation
program (year) (year)
Algeria Yes (2001) Yes (1998)
Bahrain Yes (1989) Yes (1975)
Djibouti No An old French legislation
Egypt Yes (1986) Yes (2009)
Emirates Yes (1991) Yes (1981)
Iraq Yes (1987) Yes (1981)
Jordan Yes (1994) Yes (2003)
Kuwait Yes (1997) No
Lebanon Yes (1987) No
Libya Yes (1988) Yes (1975)
Morocco Yes (1973) Yes (1998)
Oman Yes (1990) Yes (1999)
Palestine Yes (2004) Yes (2004)
Qatar Yes (1990) No
Saudi Arabia Yes (1989) No
Somalia Yes (?) No
Sudan Yes (1998) Yes (1998)
Syria Yes (2001) Yes (1965)
Tunisia Yes (1990) Yes (2003)
Yemen Yes (1983) No

32. The Psychiatrists
• The highest number of psychiatrists is
found in Qatar, Bahrain and Kuwait,
while seven countries (Iraq, Libya,
Morocco, Somalia, Sudan, Syria and
Yemen) have less than 0.5 psychiatrists
per 100,000 population.

33. Mental health workers
• Psychiatric nurses per 100,000
population range from 23 in Bahrain
and 22.5 in Emirates to 0.09 in Yemen
and 0.03 in Somalia.
• The same applies to psychologists and
social workers, with the most
substantial increase observed in
Bahrain, Emirates, Jordan, Egypt, Ku-
wait, Libya, Saudi Arabia and Yemen

34. Big mental hospitals
• Recent years have seen significant changes
in the field of mental health in the countries
of the Arab Region. Psychiatric services,
which were earlier totally confined to a few
large mental hospitals, are now gradually
being replaced by psychiatric units with
both inpatient and outpatient facilities in
general hospitals.

35. Country Psychiatric beds per
100,000
Psychiatrists
per 100,000
1998 2007 1998 2007
Algeria 14 25 1.1 2.2
Bahrain 33.8 33 3.7 5
Djibouti N.A. 7 0 0
Egypt 12.5 13 0.9 0.9
Emirates N.A. 14 0.9 2
Iraq 7 6.3 0.1 0.7
Jordan 20 15.7 1.1 1
Kuwait 47 34 2.6 3.1
Lebanon 47 75 1.2 2
Libya 56 10 0.3 0.2
Morocco 7.6 7.8 N.A. 0.4
Mental health resources in Arab countries

36. Oman 5.5 4.9 0.2 1.4
Palestine 14.2 8.8 0.8 0.9
Qatar 37.9 9.7 0.8 3.4
Saudi Arabia 6.5 11.8 2.4 1.1
Somalia N.A. 4 0.5 0.06
Sudan 0.1 2 0.2 0.09
Syria 7.8 8 N.A. 0.5
Tunisia 9.6 11.3 0.8 1.6
Yemen N.A. 18.5 0.1 0.5

37. Psychiatric nurses
per 100,000
Psychologists
per 100,000
Social workers
per 100,000
1998 2007 1998 2007 1998 2007
Algeria 1.1 4.2 0.8 0.2 0 0.4
Bahrain 13.3 23 0.5 0.8 1 1.5
Djibouti 0 0.2 0 0 0 0
Egypt 2 2 0.3 0.4 0.09 0.1
Emirates N.A. 11 0.9 1 0.6 1.2
Iraq 0.1 0.1 N.A. 0.05 0.05 0.2
Jordan 0 2 0.2 0.6 0.5 2
Kuwait 16.2 22.5 0.9 1.4 0.4 0.4
Lebanon 0.9 5.03 1.9 0.6 0.6 1.5
Libya N.A. 0.05 0.3 5 0.2 1.5
Morocco N.A. 2.02 N.A. 0.03 N.A. 0.007
Oman 0.2 5 0 0.2 0.1 0.5
Palestine 3.2 3.4 1.7 1 0.7 1.1
Qatar 7.4 10 1.4 1.2 1.7 10
Saudi
Arabia
6.3 6.4 0.5 1 0.9 2.4
Somalia 0.03 0.03 0 0 0 0.2
Sudan N.A. 0.2 0.01 0.2 0.01 0.1
Syria N.A. 0.5 N.A. 0 N.A. 0
Tunisia 3.3 0.2 0.1 0.6 0 N.A.
Yemen N.A. 0.09 3.2 1.2 0.01 0.04

38. Traditional healers
• Cultural beliefs of possessions and the
impact of Jinn or the evil eye affect
interpretation of mental symptoms.
• the first resort for the families of mental
patients is not the general practitioner, but
the traditional healers, who acquire a
special importance because of their claim
of religious background.

39. The Challenges
• The public awareness is poor.
• The governmental services are poor.
• Private services are scattered with
various standards.
• The patients and their families face the
stigma, finding the service, and paying
for it.
• Lack of mental health professionals.

40. The Challenges
• In the Arab world, health and education
budget assignment is below the recom-
mended requirements far better quality of life.
• The budget allowed for mental health as a
percentage from the total health but it is far
below the range to promote mental health
services. The mental health human resources
and the inefficient data.

41. Recommendations
• Public and governmental awareness .
• Research, training, and cooperation .
• Mental health policies and legislations
should be updated.
• Drug addiction need to have priority on
the national agenda.
• Special care should be given to the
causalities of wars, terrorism and
violence.

42. Recommendations
• Mental health professionals to work
as a team.
• Liaison psychiatry could help in
getting the support of the medical
profession.
• Child and adolescence psychiatry
should be given good attention.
• Cooperation with international
centers .

43. References :
1. Ibn Abi Usaibi'ah, Uyun al Anba, P. 45.
2. Isa, A., The History of Bimaristans in Islam,
Damascus, 1939, P. 9.
3. Noshrawy, A.R., The Islamic Bimaristans in the
Middle Ages, Arabic Translation by M. Kh.
Badra, The Arab Legacy Bul. No. 21, P 202.
4. Ibn Al-Atheer, Al-Kamel Fi al-Tareikh, The perfect
in History, Cairo, 1290 H. V. 4P. 219.
5. Ibn Joubir, Rehlat Ibn Jouber, The Journey of Ibn
Jouber, Cairo, 1358 H.

44. References
 "Mental health services in the Arab world“
. A. OKasha -Arab Studies Quarterly (ASQ). 2003

45. THANK YOU
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