Voice

Losing the Lonely War

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.

ZEIN AL-RIFAI/AFP/Getty Images

Report

Crunch Time for Egypt's Energy Mess?

Sisi is taking bold steps, including forging possible deals with Israel, to keep his country from going over a financial cliff.

Egypt is so desperate to finally come to grips with its energy and fiscal nightmares that its new government is doing the once unthinkable: rolling back generous domestic fuel subsidies and opening the door to imported natural gas from Israel.

The moves are hitting ordinary Egyptians in the pocketbook and angering those who have grown up on a steady diet of anti-Israel propaganda. Over the weekend, Egypt abruptly hiked domestic prices for energy products such as gasoline and diesel by almost 80 percent, a step that has the potential to send food prices skyrocketing as well. Egyptian officials are also speaking more warmly about Israel than they have in years. Oil Minister Sherif Ismail told Egyptian media recently that deals with Israel are "no longer taboo," and that, given the economic crisis, importing gas from Israel is not cause for "embarrassment."

Taken together, the policy shifts underscore how the country has reached a breaking point in its efforts to overcome long-standing problems with its economy that, if left untreated, could end up blowing up the new government of former defense chief Abdel Fattah al-Sisi. But taking action is not without its own dangers: Raising energy prices risks sparking a public backlash, and closer ties with Israel have been especially politically sensitive in post-Mubarak Egypt.

Still, Sisi and his advisors don't have much of a choice if they want to finally address the two-pronged problem plaguing the economies of Egypt and many others in the region. Egypt, to put it bluntly, has little money, in part because it pours about more than $10 billion a year, or roughly 10 percent of its GDP, into efforts to subsidize cheap fuel at home: Before the reforms, diesel cost about 70 cents a gallon in Egypt, versus about $4 in the United States. In the past, Egypt earned export revenues from shipping natural gas to Europe. But booming domestic demand across Egypt -- spurred, in part, by those very subsidies -- has outstripped production, meaning there's not enough natural gas left to send overseas.

That has left gas export terminals sputtering, government revenues waning, and foreign energy firms fuming. That's where importing gas from Israel could help -- if the companies involved can reach a deal on price and if both governments sign off on the deal. Bringing Israeli gas to Egypt would enable the country to restart gas exports, but some portion of Israeli gas would also likely to have to be set aside to serve the domestic Egyptian market.

Increasing gas exports again would be good for Egyptian government coffers. But politically, with blackouts rampant and factories struggling to get the energy they need, shipping more gas overseas could cause trouble. Carving off a slice of that Israeli gas to feed the Egyptian market could soothe political worries at home -- but may not sit too well with companies, such as BG Group PLC, that have already suffered plenty from a downturn in their gas export business from Egypt.

The prospect of importing gas from Israel illustrates just how dramatically the country's energy position has deteriorated in recent years. In the late 1990s, Egypt started exporting liquefied natural gas (LNG) to customers in Europe, and in 2008 it began exporting natural gas to Israel. That trade was abruptly stopped in 2012, due both to falling Egyptian gas supplies and rising tensions between Israel and Egypt after the 2011 revolution that brought down former strongman Hosni Mubarak.

Both production and exports of Egyptian natural gas peaked in 2009; production has slipped steadily since, and soaring domestic demand has helped cut exports by more than half over the past five years. Egypt is so desperate for the very gas it recently exported that it hopes to build a floating terminal on the Red Sea to import expensive LNG itself. Israel, meanwhile, is busy tapping its vast offshore oil and gas fields in the hopes of becoming a big energy exporter in the region, with Egypt a natural -- if wary -- customer.

Last week, BG, a large British gas company, signed a letter of intent with the companies running Israel's big Leviathan field to transport gas via an undersea pipeline to Egypt. The preliminary deal, which could be worth about $30 billion over 15 years, would help BG get much of the gas it needs to run its export terminal on the Egyptian coast, where gas is turned into LNG for export to Europe. It comes less than two months after the partners at another Israeli gas field, Tamar, announced a similar letter of intent to ship gas to another LNG facility in Egypt. (Noble Energy helps both Israeli operations actually extract the gas.)

Israeli gas exports to Egypt aren't a done deal. Both governments have to sign off on any accord, and final pricing terms still need to be determined. But the Egyptian government seems to be increasingly comfortable with the idea of relying, in part, on Israeli energy to keep its economy afloat -- as long as some of the gas is kept for domestic use. One Egyptian government oil official told the Wall Street Journal, "Things are different in Egypt now and we see no issue in this deal if it is beneficial for the country."

Laura El-Katiri, a specialist on the Middle East and a research fellow at the Oxford Institute for Energy Studies in London, said a deal with Israel makes sense for both countries. "There's no cheaper way to get gas at the moment in Egypt," she said.

Importing Israeli gas, in any event, likely won't materialize until the completion of the new pipelines later this decade. In the short term, tackling the energy subsidies will have the biggest immediate impact -- and potentially the biggest risks.

The 80 percent spike in the prices of gasoline and diesel came just days after the Egyptian government began gradually raising the price of electricity. In real terms, even after the price hikes, energy prices are still artificially low in Egypt -- diesel, for example, is still less than $1 a gallon even after the increase. But the government's move has folks on the street grumbling about pricier public transport and fuel costs for small businesses. There are also concerns that higher energy costs will trickle down -- through transport and agriculture -- to raise the cost of food. Expensive bread was one of the sparks that lit the 2011 revolution. That the government is knowingly accepting those risks today highlights just how dire its +fiscal situation has become.

"Either Egypt had to hit the brakes themselves, or they'd hit the wall. Those were the options. And Sisi decided to hit the brakes," said Matthew Reed, vice president at Foreign Reports, a consultancy that specializes in Middle East oil issues.

He said that Sisi's bold move contrasts with the caution of former president Mohamed Morsi, who, despite being a popularly elected Islamist politician, didn't even dare to raise so-called "sin taxes" on cigarettes and alcohol. Sisi, who is known to drink with visiting American dignitaries, did so almost immediately after taking power.

"Sisi is unique now for having walked the walk," Reed said, and the nascent reforms could reopen the door for Egypt to receive a long-stalled, $4.8 billion loan from the International Monetary Fund that it desperately needs to close a looming budget gap. The IMF has insisted Egypt make fundamental economic reforms, including reining in runaway energy subsidies.

The full impact of rolling back energy subsidies will become clearer over the summer, right when Egyptian tempers are likely to be further frayed by ever-present electricity blackouts -- caused in part by domestic shortages of natural gas -- that cut power to the country's air conditioners, televisions, and fans. Sisi's resounding electoral victory could shield him from the worst of the public backlash, and may have made this the least bad time to start the painful but necessary reforms, El-Katiri said.

"He didn't do this because he thinks it's popular," she said. "It is five minutes to midnight there, in terms of timing."

Mohamed el-Shahed - AFP - Getty