Samah Jabr: The female psychiatrist on the frontline of Palestine's post-pandemic mental health crisis

There is the young man who was diagnosed with coronavirus on his wedding day and ended up in quarantine rather than honeymooning with his bride; the businessman whose work has been interrupted because he is in isolation, and the son who feels guilty for passing the virus to a parent who is now dying.

Samah Jabr, director of the mental health unit of the Palestinian Authority Ministry of Health, oversees the response to psychiatric distress due to Covid-19.

"There is a mental health crisis accompanying the public health crisis," Jabr, who comes from Jerusalem's Shuafat neighbourhood, told The New Arab.

"People's economic situation is devastated, they are concerned about their loved ones, the routine, which gives structure to life changes and the sudden change in the structure of life confuses some people," she said.

The crisis is most severe in the quarantine and medical isolation centres. "You see severe anxiety, panic, delirium and suicide attempts sometimes," Jabr, 43, who went to medical school at al-Quds University and also studied in France, Britain, Israel and Harvard University, said.

There is a mental health crisis accompanying the public health crisis. People's economic situation is devastated, they are concerned about their loved ones

Until recently she was known abroad mostly for her criticism of the psychological damage inflicted by Israeli occupation. Now she is emerging as a crucial if unsung player in the PA's life and death battle against coronavirus.

"In the general public we see health anxieties, relapses of Obsessive Compulsive Disorder and pre-existing disorders," she says. "We see distress due to financial causes, too much friction and conflicts within the family due to spending too much time together at home, fights between engaged couples because they have to postpone their marriage party and husbands distressed because their wives are so strict on cleaning."

Read more: Desperate and trapped, Gaza's youth turn to suicide

Those may be universal Covid-19 psychological issues, but in Palestine there is also another that is particularly pronounced, a phenomenon Jabr refers to as Sudden Traumatic Death Syndrome, where family members who normally would be at their parent's bedside are traumatised by having to leave them alone.

They think repeatedly of their relative dying alone and when it does happen there is no funeral or open house for condolences because of safety restrictions.

"Fear of traumatic death is more important than fear of death itself," says Jabr. "People are very concerned about leaving their parents alone in the medical centres." And being alone harms the patients.

"The elderly become delirious and don't see the facial features of the health providers. There is increased alienation which contributes to delirium."

The lack of funerals and post-death visiting of mourners "is an important concern that I hear from people who lost loved ones. It bothers them a lot," Jabr says.

Jabr, who lives with her elderly parents, is a pioneer and improvisor in a severely underdeveloped area when it comes to psychiatric care. There are only 22 psychiatrists for a population of three million in the West Bank. Working up to fourteen hours a day, she oversees fourteen mental health centres and a psychiatric hospital and devised the mental health response plan to Covid-19.

In the Middle East and the world, mental health is not seen. There is less empathy for mental health because it is invisible

The psychiatric help is given over the phone or via computer by staffers trained by Jabr. While she has positive things to say about PA health minister Mai al-Kaila, her unit is allocated only two percent of the health ministry's budget.

"There is a lot to change in the attitude of decision makers," she says. " I need to tackle misconceptions that because mental health problems are not visible, they don't exist."

"In the Middle East and the world, mental health is not seen. If you want to show a person has an infection, you can do so with a chest x-ray, there is material proof. There is less empathy for mental health because it is invisible."

Read more: How Palestine's Red Crescent is taking charge of the coronavirus response

Jabr says she also runs up against decision makers who wrongly blame all psychological ills on the occupation and use this as an excuse for doing nothing.

A further challenge is that awareness of mental health is very limited among the populace. When it comes to changes in behaviour due to psychosis, "the most common attribution people make is possession by jinns or black magic or witchcraft."

Jabr believes it is not effective at first to unabashedly reject these beliefs. "I don't argue with their attribution much in the beginning. I pick on symptoms they want to get rid of, for example sleeplessness, and I tell them that 'I can get rid of that noise in your head.'"

The daughter of a professor of educational psychology, Jabr became interested in her field by reading the books used by her father. Palestine's top psychiatrist is well educated, including a three-year programme at the Israel Institute for Psychoanalytic Psychotherapy. She says she has no contact with Israelis in her official capacity but keeps in touch privately with several Israeli colleagues whom she respects.

Even Jabr herself needs help during these trying times, she concedes. "The job demands so much of me. I've always been active doing too many things but this period demands a lot of changes and adaptations and I recruit help from others. I don't compromise my well-being."

"I want to be useful for a long time," she says.

Ben Lynfield is a journalist currently based in Jerusalem.