Suicide is becoming a crisis among people affected by Syria's protracted civil war -- and no one is talking about it.
Her hands showed every tendon, and her arms were like matchsticks. With a grayish tint to her face, Alma Abdulrahman, 27, spoke from a hospital bed in Amman, Jordan, one year ago about the torture and rape she'd endured at what she said were the hands of the Syrian government. Paralyzed from her diaphragm down, she spoke in an exhausted voice over Skype to me in New York last June.
She described being stuffed into a tire and beaten, being drugged and sexually assaulted twice a day while passing in and out of consciousness, and being whipped with a wire during two separate detention periods that lasted each about a month. As she did, Abdulrahman wavered between anger, despair, and a resolve to speak: "You know, these are things no one talks about but I'm going to share them with you because I want the whole world to listen and see."
Having joined the Free Syrian Army early in the revolution, Abdulrahman said she rose to the rank of battalion commander, becoming the rare woman on the front lines, overseeing about 15 men. Paralysis came after her second detention, when a soldier struck her in the neck with a rifle at a regime checkpoint. She told me she'd killed at least nine men.
"If I weren't so strong, I would have died a long time ago," she said, claiming to be "working" from the hospital by facilitating a way for her fellow revolutionaries to receive medications from physicians in Daraa, in southern Syria. "If I was able to sit up -- I swear by God -- if I could just sit up, I would return to help the cause. I would assist the injured, in the very least."
Her resolve, however, was plainly wavering.
"I am only a spirit and a voice now," she said.
"I am practically dead."
"I am only a soul."
Abdulrahman endured torture and rape, separation from her children, paralysis, and loneliness. She lasted longer than many would in her position. But on June 14, 2014, everything ended: Abdulrahman died, bereft and alone, in a Jordanian hospital.
"Hopeless," a psychiatrist who treated her early on and followed her health told me. "She was hopeless."
Psychiatrist Yassar Kanawati, who oversees a psychosocial team in Amman for the Syrian American Medical Society, described how Abdulrahman was "refusing to eat, refusing to take medicine. They put a gastric tube [but] she would wake up and take it out." The hospital had recently informed Abdulrahman that they had no more money for her care; her family and friends had abandoned her, according to Kanawati. "Nobody came," she said. Kanawati speculated that her friends had either moved on in the tides of refugees or died.
"She said, 'What kind of life is this?'" Kanawati told me. "It wasn't much."
Abdulrahman ultimately died of dehydration.
Abdulrahman had endured torture that would seem unimaginable except for the fact that it is happening so frequently. In April, United Nations High Commissioner for Human Rights Navi Pillay said torture was routinely being used in government detention facilities and "almost certainly" in "a systematic or widespread manner." Mental health support, as I recently wrote, is nearly nonexistent, both for Syrians who've suffered torture and for those who have not, both inside their country and in nearby states holding burgeoning numbers of refugees. And now suicide, according to doctors and social workers I spoke with, is rapidly becoming a very real fallout of this war -- one that is so taboo, it is rarely spoken of within families, let alone publicly.
"Suicide is strictly forbidden in Islam," said Haid N. Haid, a Beirut-based Syrian sociologist and Middle East program manager at the Heinrich Boll Foundation. Scholars often forbid the recitation of a funerary prayer for people who've committed suicide, as a way to punish the families of the dead and to deter others from taking their own lives. The cause of death is usually obscured -- it is called an "accident" or "natural." Suicide, Haid emphasized, is always "a big scandal that people will talk about for a long time."
Despite the taboo, doctors I spoke with said they are seeing more and more cases of people with suicidal impulses -- a trend confirmed by the number of reported instances in which, because of a feeling of being unable to provide for one's family as a refugee, or because of the shame of rape, pregnancy through rape, or sexual humiliation, it has been carried out. Hard data are difficult to come by. But while I was unable to find formal statistics on suicide in the Syrian war, the picture painted by doctors working in and near the country is decidedly bleak -- and given how precious few mental health services are available to Syrians affected by the war, it is probably just the tip of the iceberg.
"About 70 percent of all our clients have thoughts about dying, but for many they say their religion keeps them from doing harm to themselves," said Adrienne Carter, a psychotherapist who works in Jordan at the Center for Victims of Torture, a nonprofit that offers mental health care and rehabilitation to survivors. Carter said that she believes her Syrian clients have a higher rate of suicide than people she works with from other Muslim nations. She estimates that 3 to 4 percent of her clients walk in "highly suicidal." Right now, the center has 693 people waiting for its services.
For some, suicide is "the last escape from a world of misery," said Salah Ahmad, a psychotherapist and the director general of the Jiyan Foundation for Human Rights (formerly the Kirkuk Center for Torture Victims). "Most of my patients who wanted to kill themselves perceived themselves as 'worthless,' either because they had psychological or social problems before their flight, or because they lost everything and did not see any future perspectives for themselves or their families."
For women, Ahmad said, "the situation is especially hard because they have no one to support them," with their husbands and male relatives either killed or detained.
On Tuesday, the UNHCR released a report that estimates that 145,000 Syrian women are now heading up one in four refugee households throughout the Middle East. Their circumstances are made worse by being unable to pay rent, feed their children, or buy basic goods. Extremely poor and suddenly the main breadwinners of their houses, they are all struggling with the trauma of losing their loved ones on top of everything else. Only one-fifth of these women have work, according to the report. One in three say they are too scared to even leave their houses.
In the absence of firm suicide statistics, a handful of news reports have described horrific death scenes, especially for women. They have reportedly thrown themselves off rooftops and set themselves on fire.
One case that particularly stands out to Yassar Kanawati is that of a woman who is the sole survivor of a bombing of a school in Aleppo that was preparing an exhibition of art made by children about the war. The woman was their art teacher and the exhibition's organizer. At least 20 people, including two teachers and 17 children, aged eight to 12, had been killed. Now living in southern Turkey with shrapnel in her back, she is refusing treatment, Kanawati said, because she suffers severe depression and survivor's guilt. "I see them all in my dream every night," the teacher told Kanawati. "I feel responsible and guilty for their death. I wake up wishing I died with them."
She also said, "I need to be with them."
Guilt and depression are two symptoms I left in the background when I first told Abdulrahman's story last year for the Atlantic. I was told by doctors and social workers that she was a "broken" woman. She was requesting medicine to sleep, refusing food, and hurting from injuries old and new: both burns from her torture and bedsores wept from her body. She was having suicidal thoughts.
I chose not to include this information because of Islam's taboo around taking one's own life, as well as the fact that her internal mental state felt private -- I didn't want to compromise her publicly and have that overshadow her story, which illustrated the severity of sexualized violence and torture in Syria. I'm sharing it now because Abdulrahman's death, and the way it came about, is also emblematic of what many thousands of Syrians are enduring: a lack of health care, isolation, poverty, terror. The mental pain is so intense that, for many, dying is preferable to continuing to live as the war gets worse and worse.
A year ago, I wrote that the horrors Abdulrahman described "have positioned her to become the face of powerful women survivors in Syria." I still believe that to be true. Only now, perhaps, her decision to end her time in that hospital bed can be seen as a call to the world to pay attention to the suffering that is so immense that even the most powerful can no longer survive.
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